Background. Postoperative pulmonary complications are a wide variety of disorders that affect normal respiratory functions, which in turn lead to morbidity and mortality. The extent to which it occurs is not yet studied in most clinical settings. This study assessed the incidence and risk factors of postoperative pulmonary complications in patients undergoing abdominal surgery under general anesthesia. Methods. A multicenter, prospective cross-sectional study was conducted at Menelik II, Tikur Anbessa Specialized, Zewditu Memorial, and Yekatit 12 Memorial hospitals after obtaining ethical clearance from each hospital. The study recruited a total of 287 participants using systematic random sampling. The data collection tool included sociodemographic, surgical, and anesthetic factors. Participants were followed for 7 days postoperatively, and any respiratory problems were recorded once identified. The collected data were entered and analyzed using SPSS version 26. Both bivariate and multivariate logistic regressions were used for analysis. A
p
value of <0.05 was considered statistically significant. Results. About 33% of the participants that underwent abdominal surgery developed postoperative pulmonary complications. Age > 65 years (AOR = 12.091, 95% CI = 3.310–44.169), duration of surgery >3 hours (AOR = 11.737, 95% CI = 3.621–38.039), preoperative oxygen saturation <94% (AOR = 10.671, 95% CI = 3.794–30.016), and postoperative serum albumin level <3.5 g/dl (
p
value <0.001) were associated with postoperative pulmonary complications significantly. Conclusion and Recommendations. The incidence of postoperative pulmonary complications after abdominal surgeries was high. Age >65years, duration of surgery >3 hours, preoperative SpO2% <94%, cigarette smoking, and postoperative serum albumin level <3.5 g/dl were factors strongly associated with postoperative pulmonary complications. We recommend special care for elderly patients, limit the surgical duration to less than 3 hours, treat the underlying cause of desaturation, and correct postoperative serum albumin to prevent the occurrence of postoperative pulmonary complications.
Background
Postanesthesia shivering is one of the potential complications of anesthesia which may increase patient morbidity. Various methods have been employed to control postoperative shivering. This study assessed the effectiveness of prophylactic low-dose intravenous ketamine and pethidine for postoperative shivering after general anesthesia.
Methods and materials:
This prospective cohort study recruited 76 ASA I and II patients aged 18–65 years old and underwent elective surgery under general anesthesia. The patients were grouped based on either ketamine 0.5mg/kg or pethidine 0.5 mg/kg having been administered by the anaesthetist in charge as a prophylaxis for postoperative shivering 20 minutes before completion of the surgery. The incidence and severity of postoperative shivering were compared between the two groups every 10 minutes until one hour postoperatively. The side effects of the study drugs were also compared between the two groups in the recovery room. Categorical data were analyzed with the Chi-Square test. Parametric and nonparametric data between the groups were analyzed using independent samples t-test and Mann-Whitney U test, respectively. A p-value of < 0.05 was considered statistically significant.
Results
The incidence of shivering between the ketamine and pethidine groups was 11(28.2%) and 14(35.9%), respectively (p = 0.467). The severity of shivering was not significantly different between the two groups (p = 0.893). The occurrence of nausea and vomiting and sedation attributed to the drugs was significantly less in the ketamine group (p < 0.05). PACU stay duration and occurrence of hallucinations among the groups were comparable. (p > 0.05)
Conclusion and Recommendation:
This study revealed administering low-dose IV ketamine (0.5mg/kg) 20 minutes before completion of surgery reduced postoperative shivering as nearly equally as pethidine. The study also showed clinically better outcomes in favor of ketamine since it was associated with fewer side effects. Thus, we recommend low-dose IV ketamine 20 minutes before completion of surgery under general anesthesia to prevent postoperative shivering.
Background: Postanesthesia shivering is one of the potential complications of anesthesia which may increase patient morbidity. Various methods have been employed to control postoperative shivering. This study assessed the effectiveness of prophylactic low-dose intravenous ketamine and pethidine for postoperative shivering after general anesthesia.Methods and materials: This prospective cohort study recruited 76 ASA I and II patients aged 18-65 years old and underwent elective surgery under general anesthesia. The patients were grouped based on either ketamine 0.5mg/kg or pethidine 0.5 mg/kg having been administered by the anaesthetist in charge as a prophylaxis for postoperative shivering 20 minutes before completion of the surgery. The incidence and severity of postoperative shivering were compared between the two groups every 10 minutes until one hour postoperatively. The side effects of the study drugs were also compared between the two groups in the recovery room. Categorical data were analyzed with the Chi-Square test. Parametric and nonparametric data between the groups were analyzed using independent samples t-test and Mann-Whitney U test, respectively. A p-value of <0.05 was considered statistically significant. Results: The incidence of shivering between the ketamine and pethidine groups was 11(28.2%) and 14(35.9%), respectively (p=0.467). The severity of shivering was not significantly different between the two groups (p=0.893). The occurrence of nausea and vomiting and sedation attributed to the drugs was significantly less in the ketamine group (p<0.05). PACU stay duration and occurrence of hallucinations among the groups were comparable. (p>0.05)Conclusion and Recommendation: This study revealed administering low-dose IV ketamine (0.5mg/kg) 20 minutes before completion of surgery reduced postoperative shivering as nearly equally as pethidine. The study also showed clinically better outcomes in favor of ketamine since it was associated with fewer side effects. Thus, we recommend low-dose IV ketamine 20 minutes before completion of surgery under general anesthesia to prevent postoperative shivering.
Background: Intraoperative hyperglycemia is a common problem among patients undergoing orthopedic surgery. Its incidence varies from country to country and not clearly studied in developing countries.
Method:Multi-center cross-sectional study was conducted on eligible adult elective patients who underwent orthopedic surgical procedures. The participants were selected using a systematic random sampling technique. Data was collected on basic characteristics, medical and surgical history. On the arrival of patients to the OR, blood glucose was measured and recorded and repeated after administering anesthesia. The data was analyzed using descriptive statistics and bivariate and multivariate logistic regression. P<0.05 was considered as statistically significant.
Results: Intraoperative hyperglycemia was observed in 20.4% of patients. Hypothermia (AOR:2.45;95% CI:0.97-6.27, p=0.05), infused dextrose iv fluids (AOR:2.94;95% CI:1.64-5.16, p=0.05) , blood transfusion (AOR:6.64;95% CI:2.92-15.08, p=0.00) and history of hypertension (AOR:2.19;95% CI:1.23-3.71, p=0.01) were factors identified to be associated with intraoperative hyperglycemia.
Conclusions and recommendations
This study showed the magnitude of intraoperative hyperglycemia was high. Anesthetists should identify all risk factors preoperatively and make appropriate adjustments for patient care. Hypertension should be optimized, refrain from routine administering of dextrose IV fluids, and unnecessary transfusions, as well as monitor patients’ body temperature.
Background
A significant proportion of patients suffer moderate to severe pain after surgery despite wide pain management protocols. Many analgesic drugs have been tried to alleviate perioperative pain. This study aimed at evaluating the effectiveness of diclofenac as a preemptive analgesic for postoperative pain management in patients that underwent abdominal hysterectomy under general anesthesia.
Methods
A total of 86 ASA I and II participants aged > 18 years old and undergoing abdominal hysterectomy from March to August 2020 in Adama General Hospital were recruited into this prospective observational cohort study. Study participants were grouped as group D (who took preemptive diclofenac) and group ND (who did not) based on whether or not IV diclofenac was given 30 minutes before the surgical incision. The pain severity, total analgesic consumption, first analgesic request time, and incidence of nausea and vomiting within 24 hours postoperatively were compared between the two groups. Student’s t-test and Mann-Whitney U test were used for analyzing numeric data. Categorical variables between the groups were analyzed using the chi-square test. P-values < 0.05 were considered statistically significant.
Results
Median pain score in the early postoperative period (in the 2nd, 4th, and 8th hr) was significantly lower in the diclofenac group (0.007, 0.004, 0.001, 0.261, and 0.796 respectively). The mean first analgesic request time between the groups was not significantly different (p > 0.05). Total postoperative analgesic consumption was significantly lower in the diclofenac group (p = 0.0006). The occurrence of nausea and vomiting was comparable between the two groups (p > 0.05).
Conclusion and Recommendation:
Preemptive diclofenac significantly reduced postoperative pain severity and total analgesic consumption and was associated with fewer side effects in patients undergoing gynecologic surgery. We recommend that all anesthesia providers use 75 mg of diclofenac 30 min to 1 hour before surgical incision.
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