BACKGROUND:Competency in neonatal resuscitation is critical in the delivery rooms, neonatology units and pediatrics intensive care units to ensure the safety and health of neonates. Each year, millions of babies do not breathe immediately at birth, and among them the majority require basic neonatal resuscitation. Perinatal asphyxia is a major contributor to neonatal deaths worldwide in resource-limited settings. Neonatal resuscitation is effective only when health professionals have sufficient knowledge and skills. But malpractices by health professionals are frequent in the resuscitation of neonates. The present study was to assess the knowledge and skills of health professionals about neonatal resuscitation. METHODS:An institution based cross-sectional study was conducted in our hospital from February15 to April 30, 2014. All nurses, midwives and residents from obstetrics-gynecology (obsgyn), midwifery and pediatric departments were included. The mean scores of knowledge and skills were compared for sex, age, type of profession, qualification, year of service and previous place of work of the participants by using Student's t test and ANOVA with Scheffe's test. A P value <0.05 was considered statistically significant. RESULTS:One hundred and thirty-five of 150 participants were included in this study with a response rate of 90.0%. The overall mean scores of knowledge and skills of midwives, nurses and residents were 19.9 (SD=3.1) and 6.8 (SD=3.9) respectively. The mean knowledge scores of midwives, nurses, pediatric residents and obs-gyn residents were 19.7 (SD=3.03), 20.2 (SD=2.94), 19.7 (SD=4.4) and 19.6 (SD=3.3) respectively. Whereas the mean scores of skills of midwives, nurses, pediatric residents and obs-gyn residents were 7.1 (SD=4.17), 6.7 (SD=3.75), 5.7 (SD=4.17) and 6.6 (SD=3.97) respectively. CONCLUSIONS:The knowledge and skills of midwives, nurses and residents about neonatal resuscitation were substandardized. Training of neonatal resuscitation for midwives, nurses and residents should be emphasized.

Summary: labor pain is described as the most severe pain experienced ever by most women where majority of parturients complained their pain as severe or extremely severe. This stressful condition leads to negative impacts on maternal and fetal physiology. Optimal method of evidence-based management of pain in laboring mothers remains in debate. There is variety of controversial approaches based on different evidences. Therefore, it is important to review recent articles to recommend a relatively safe method that is feasible in our clinical set up to provide appropriate method of labor pain management. The objective of this review was to indicate safer options of labor pain management that help improve maternal care regarding pain management. Methods: Google Scholars, PubMed through HINARI, and other search engines were used to search high quality evidences that help to reach appropriate conclusions. Discussion: Compared with other techniques, Epidural analgesia is acknowledged as the most effective and the gold standard of labor pain management. Even though epidural analgesia was thought to prolong second stage of labor and increase the rate of instrumental delivery, recent studies have proved that duration of labor and incidence of instrumental delivery is comparable between those who receive epidural and parenteral opioids, there was less neonatal depression, better maternal satisfaction and no increased risk of the rate of cesarean section during labor epidural. Conclusion: In the absence of a medical contraindication, maternal request is a sufficient indication for pain relief during labor. The challenge of labor pain management is the choice of the technique. The management should be guided by a thorough evaluation to identify indications and contraindications, and the technique of management should be safe for both the mother and the fetus. Highlights:

Background Caesarean delivery can be associated with considerable postoperative pain. While the benefits of transversus abdominis plane (TAP) and ilioinguinal-iliohypogastric (II-IH) nerve blocks on pain after caesarean delivery via Pfannenstiel incision have been demonstrated, no enough investigations on the comparison of these blocks on pain after caesarean delivery have been conducted in our setup. Method An institutional-based prospective observational cohort study was conducted to compare the analgesic efficacy of those blocks. We observed 102 postoperative parturients. The outcome measure was the severity of pain measured using a numeric rating scale. Result Twenty-four hours after surgery, the NRS score at rest was (0.90 ± 0.80) versus (0.67 ± 0.58) and at movement (1.2 ± 1.07) versus (0.88 ± 0.76) for the TAP and II-IH groups, respectively. Twenty-four hours after surgery, the mean tramadol consumption was (55.45 ± 30.51) versus (37.27 ± 27.09) mg in TAP and II-IH groups, respectively (p = 0.009). The mean first analgesic requirement time was also prolonged in the II-IH group. Conclusion and Recommendations There was no statically significant difference between TAP and II-IH blocks regarding postoperative pain score, but the II-IH block significantly reduced the total tramadol consumption and prolonged the time to first analgesic request than TAP. Thus, we recommend the II-IH nerve block.

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Background: Hypoxemia is defined as low level of oxygen in the blood. The early postoperative period is a critical time for developing hypoxemia. It is well known that the physiological response of the patient is not reversed immediately after anesthesia and surgery. Supplemental oxygen should be considered in patients who had operation under anesthesia at the potential time of post-operative period. Objective: The objective of this study was to determine the incidence of early post-operative hypoxemia and its contributing factors among operated patients under anesthesia during transportation to recovery rooms and at recovery rooms. Methods: A prospective observational study design was conducted to determine the incidence of early post-operative hypoxemia and to identify the contributing factors among operated patients who had undergone with anesthesia from March 1 to April 10, 2018. Data were checked on daily basis. Data were entered to Epi Info and analyzed by statistical package for social sciences (SPSS) version 20 software. Descriptive statistics were used to summarize patient's sociodemographic data. Bivariate and multivariate binary logistic regressions were conducted to see the existence of the association between dependent and independent variables. Results: 424 operated patients were included. The overall incidence of early post-operative hypoxemia among the study subjects (424) was 113 (26.7%). The risk factors of early post-operative hypoxemia were preoperative oxygen saturation <95%, general anesthesia, heart disease, subcostal incision, surgical duration ≥120 min, muscular strength score 0 and hepato-biliary-pancreas surgeries. Conclusion: The incidence of early postoperative hypoxemia was high and risk factors of early post-operative hypoxemia were preoperative oxygen saturation<95%, general anesthesia, heart disease, subcostal incision, surgical duration >120 min, muscular strength score 0 and hepato-biliary-pancreas surgeries. Therefore, oxygen administration should be commenced to all risky patients for hypoxemia during early post-operative period. Highlights:

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Introduction: Emergence agitation is one of the significant anesthetic and surgery-related complications. It is usually short-lived but causes self-injury during agitation and it led to parental anxiety. This study was aimed to assess incidence and factors associated with emergence agitation after general anesthesia and surgery among pediatric patients at University of Gondar specialized hospital. Methods: A prospective follow-up study conducted on 153 pediatric patients aged 2–9 years who were operated from first February to April 30, 2019. Emergence agitation was recorded by the pediatrics anesthesia emergence delirium scale. Descriptive statistics performed to determine the incidence. To identify the associated factors multi-variable binary logistic regression was held, and a p-value <0.05 was considered as significant. Results: Emergence agitation was experienced on eighty (52.3%) children with a mean and standard deviation of 12 ± 5.9 min of duration. Among agitated children, 8 (10%) of them developed adverse events related to agitation. Difficult parental separation behaviour (AOR = 2.688, 95% CI = 1.131–6.39), children aged 2–5 years (AOR = 2.688, 95% CI = 1.131–6.3925), isoflurane maintenance (AOR = 4.001, 95% CI = 1.733–9.234) and propofol administration after maintenance closure (AOR = 0.145, 95% CI = 0.030–0.695) were significantly associated with agitation. Conclusion: Being a preschool child, difficult parental separation and isoflurane maintenance were associated with emergence agitation. But propofol administration after maintenance closure was found to be protective. So, agitation should be assessed and detected in the postoperative period and efforts should apply to prevent emergence agitation. Highlights:

The perioperative period is a time in which significant physiological change occurs. Improper transfer of information at this point can lead to medical errors. Planning and preparation for critical patient transport to ICU is vital to prevent adverse events. Critical patient transport to ICU must be as safe as possible and should not cause additional risks. It needs good communication, planning, and appropriate staffing with standard monitoring. Evidence shows inconsistency and variability on the use of standardized protocols during critical patient transfer and handover to the ICU. There is a variety of controversial approaches about the need of sedation, use of end-tidal CO2 monitoring, and manual versus mechanical ventilation based on different evidence. The objective of this review was to recommend safer options of critical patient transfer to the ICU that help reduce patient morbidity and mortality. Methods. Google Scholars, PubMed through HINARI, and other search engines were used to search high-quality evidence that help reach appropriate conclusions. Discussion. Critical patient transfer and handover to ICU is a complex procedure that needs experienced hands, availability of appropriate team members, standard monitoring, and necessary emergency and patient-specific medications. Appropriate and adequate transfer of patient information to the receiving team decreases patient morbidity and mortality when the transfer team uses standardized checklist. Conclusion. Involvement of senior physicians, use of standard monitoring, and appropriate transfer of information have been shown to decrease critical patient morbidity and mortality.