Background: Post dural puncture headache (PDPH) has been a problem for patients after dural puncture. It is one of the most frequently occurring complications following spinal anesthesia (SA). It is believed to originate from persistent leakage of cerebrospinal fluid (CSF) through the punctured Dura, greater than the CSF production after lumbar puncture. Although the problem has been widely reported, its magnitude and associated factors has never been studied in our country. Thus, the aim of this study is to assess the magnitude of post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of Gondar referral and teaching hospital.

Objective To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia. Methods Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable. Result The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening < 30 mm and Mallampati classes III and IV are the most sensitive tests and second high specific test next to combination of tests to predict difficult intubation and laryngoscopy (P value < 0.001). Unrestricted multiple attempt without alternative airway techniques resulted in exponential increase in desaturation episodes and further difficulty of airway management (P value < 0.001). Discussion and Conclusion Mallampati classes III and IV, mouth opening ≤ 30 mm, jaw slide grade C, attempt > 3, and ineffective alternative technique have increased predictability value of difficult airway.

Background Adapting and translating already developed tools to different cultures is a complex process, but once done, it increases the validity of the construct to be measured. This study aimed to assess the 12 items WHODAS-2 and test its psychometric properties among road traffic injury victims in Ethiopia. This study aimed to translate the 12 items WHODAS- 2 interview-based tools into Amharic and examine the psychometric properties of the new version among road traffic injury victims. Methods The 12 items WHODAS 2 was first translated into Amharic by two experts. Back translation was done by two English experts. A group of experts reviewed the forward and backward translation. A total of 240 patients with road traffic injury completed the questionnaires at three selected Hospitals in Amhara Regional State. Internal consistency was; assessed using Chronbach’s alpha, convergent, and divergent validity, which were; tested via factor analysis. Confirmatory factor analysis (CFA); was computed, and the model fit; was examined. Results The translated Amharic version 12 –items WHODAS-2 showed that good cross-cultural adaptation and internal consistency (Chronbach’s α =0.88). The six factor structure best fits data (model fitness indices; CFI = 0.962, RMSEA = 0.042, RMR = 0.072, GFI = 0.961, chi-square value/degree of freedom = 1.42, TLI = 0.935 and PCLOSE = 0.68). Our analysis showed that from the six domains, mobility is the dominant factor explaining 95% of variability in disability. Conclusion The 12 items interview-based Amharic version WHODAS-2; showed good cultural adaptation at three different settings of Amhara Regional State and can be used to measure dis-ability following a road traffic injury.

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.

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:

BackgroundCholecystectomy can be associated with considerable postoperative pain. While the benefits of paravertebral block (PVB) on pain after thoracotomy and mastectomy have been demonstrated, not enough investigations on the effects of PVB on pain after open cholecystectomy have been conducted. We tested the hypothesis that a single-injection thoracic PVB reduces pain scores, decreases opioid consumption, and prolongs analgesic request time after cholecystectomy.MethodsOf 52 patients recruited, 50 completed the study. They were randomly allocated into two groups: the paravertebral group and the control group. The outcome measures were the severity of pain measured on numeric pain rating scale, total opioid consumption, and first analgesic request time during the first postoperative 24 hours.ResultThe main outcomes recorded during 24 hours after surgery were Numerical Rating Scale (NRS) pain scores (NRS, 0–10), cumulative opioid consumption, and the first analgesic request time. Twenty four hours after surgery, NRS at rest was 4 (3–6) vs 5 (5–7) and at movement 4 (4–7) vs 6 (5–7.5) for the PVB and control groups, respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four hours after surgery, median (25th–75th percentile) cumulative morphine consumption was 0 (0–2) vs 2.5 (2–4) mg (P<0.0001) and cumulative tramadol consumption was 200 (150–250) mg vs 300 (200–350) mg in the paravertebral and in the control group, respectively (P=0.003). After surgery, the median (25th–75th percentile) first analgesic requirement time was prolonged in the PVB group in statistically significant fashion (P<0.0001).Conclusion and recommendationsSingle-shot thoracic PVB as a component of multi-modal analgesic regimen provided superior analgesia when compared with the control group up to 24 postoperative hours after cholecystectomy, and we recommend this block for post cholecystectomy pain relief.

Practices of regional nerve block here in Gondar University Referral Hospital are expanding with multiple techniques and different approaches with increasing availability of equipments and medications. The demands of documentation of regional nerve block are growing well ,however there are no specified protocols which should be recorded for each individual nerve block, no separate record

BackgroundRoad traffic injury-related mortality continues to increase from time to time globally, but its burden is more than three times higher in low-income countries. This discrepancy is mainly due to poor trauma care system both at the pre-hospital and in-hospital. The analysis of injury patterns and time to mortality is crucial for the development and improvement of trauma care systems. This study aimed to identify patterns of RTI , and predictors of mortality following a RTI. MethodsA prospective hospital-based follow up study was conducted among road traffic injury victims admitted to Gondar University Hospital between May 2019 and February 2020. The total follow-up time was 30 days. Injury severity was determined using revised trauma score (RTS). A Cox regression model was used to identify the time to death and predictors of mortality. Hazard ratios (HR), attributable risks (AR) and population attributable percent (PAR) were computed to estimate the effect size and public health impacts of road traffic injuries.ResultsA total of 454 victims were followed for 275,534 person-hours. There were 80 deaths with an overall incidence of 2.90 deaths per 10,000 person-hours of observation (95% CI: 2.77, 3.03). The significant predictors of time to death were being a driver (AHR=2.26; 95% CI: 1.09, 4.65, AR=14.8), accident at inter urban roads (AHR=1.98; 95% CI: 1.02, 3.82, AR=21%), hospital arrival time (AHR=0.41; 95% CI: .16, 0.63; AR= 3%), SBP on admission (AHR= 3.66; 95% CI: 2.14, 6.26; AR=57%), GCS of <8 (AHR= 7.39; 95% CI, 3.0819 17.74464;AR=75.7%), head injury with polytrauma (AHR= 2.32 (1.12774 4.79; AR=37%) and interaction of distance from hospital with pre-hospital care.ConclusionThis study demonstrated that trauma deaths follow the classical tri-modal pattern in low resource settings. Interventions on pre hospital care, and advancing the hospital trauma care system is required to reduce preventable deaths caused by road traffic injuries. We recommend further study that assess capability of primary hospitals in the area in providing primary trauma care.