Background Hemodynamic instability, which is an independent predictor of long-term patient morbidity and duration of stay in the hospital, is a risk for patients in the post-anesthesia care unit. Multiple factors contribute to the development of postoperative hemodynamic instability. Prevention and treatment of these factors may reduce patients' hemodynamic instability, and its associated morbidity and mortality. Objective The aim of this study was to determine the incidence and factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit. Method An institution-based prospective follow up study was conducted from April 20, 2021 to June 28, 2021. Four hundred and seventeen (417) adult surgical patients were involved in this study. Descriptive and analytic statistics were used to describe our results. Both the bivariable and multivariable logistic regression with crude odds ratio and adjusted odds ratio were used with a 95% confidence interval to evaluate the strength of association. In multivariable regression, a p-value < 0.05 was considered as statistically significant. Result The overall incidence of hemodynamic instability was 59.47% (CI: 0.55, 0.64). The incidence of tachycardia, bradycardia, hypotension, and hypertension were 27.34%, 21.82%, 13.67%, and 15.35% respectively. Preoperative use of beta-blockers, ASA class III, procedure longer than 4 h, intraoperative hemodynamic instability, and regional anesthesia were significantly associated with hemodynamic instability in the post-anesthesia care unit. Conclusion and recommendation The incidence of hemodynamic instability in the post anesthesia care unit was high. Preoperative use of beta-blockers, intraoperative hemodynamic instability, and prolonged duration of procedures were predictors of hemodynamic instability after operation. Early detection and management of these perioperative risk factors is necessary to reduce hemodynamic instability in the post-anesthesia care unit.
Objective: This study aimed to assess the prevalence and associated factors of acute postoperative pain after emergency abdominal surgery in the first 24 postoperative hours among adult patients. Methods: An institutional-based cross-sectional study was conducted on adult patients undergoing emergency abdominal surgery at the University of Gondar Comprehensive Specialized Hospital from March 1 to May 30, 2020. Data were collected by delivering questionnaires through interviews and reviewing the patients’ charts. Data were entered into Epi Info software, version 7.2, and analyzed by SPSS version 20. Logistic regression was applied to point out independent risk factors for postoperative acute pain. Variables with a p-value of < 0.05 were taken as significant. Results: 165 patients participated in the study with a response rate of 98.2%. Among these, 75.8% [95% CI: (69.8%, 82.3%)] of patients experienced moderate to severe acute postoperative pain. Female gender [AOR:3.9, 95%CI: (1.22,12.5)], preoperative anxiety[AOR:4.4,95%CI:(1.74,11.1)],moderate to severe preoperative pain[AOR:5.79,95%CI:(2.08,16.1)], and incision length ≥10cms [AOR: 4.86, 95%(CI:1.88,12.5)], were significantly associated with moderate to severe acute postoperative pain. Conclusions and Recommendations: The prevalence of immediate postoperative pain following emergency abdominal surgery was found to be high in this study. Acute postoperative pain was substantially linked to the female sex, preoperative anxiety, preoperative pain, and an incision length of ≥10 cm. The prevalence of moderate-to-severe acute postoperative pain as well as the factors that contribute to it can be used to develop particular preventive strategies to reduce patient suffering.
Background Pulmonary aspiration of gastric contents is a rare but catastrophic cause of anesthesia related morbidity and mortality of surgical patients. The risk of pulmonary aspiration is high in surgical patient due to multiple factors. The aim of this study was to assess the practice of aspiration prevention and prophylaxis usage for patients prior to surgery. Method A cross-sectional study was conducted from 10 April 2022 to 20 April 2022. Data were collected by the direct observation and patient interview. The standards were directly changed in to questionnaire form with two integral components ‘yes’ and ‘no”. Data were entered and analyzed using statistical package of social sciences (SPSS) version 20. Result A total of 200 surgical patients were included with a response rate of 100%. Preoperative information provision to elective surgical patients on fasting requirements and the reason for them in advance of their procedures was implemented in 63% of the patients. The verification of fasting requirement was provided in 94% of elective patients. About 62.5% of elective surgical patients received gastrointestinal stimulants preoperatively. Metoclopromide was administered for 94% of emergency patients. Conclusion and recommendation The practice of preoperative fasting and administration of prophylactic agents for pulmonary aspiration is quite limited in our setup. Moreover, adherence to the recommendations of American Society of Anesthesiologist (ASA) and European Society of Anesthesiologist (ESA) was also suboptimal. We strongly recommend clinicians to use appropriate prophylactic agent to the right patient and adherence of the clinician to the local guideline on prevention of pulmonary aspiration. Highlights
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