Siraj Ahmed - Profile on Academia.edu (original) (raw)
Papers by Siraj Ahmed
Critical Care
Background The global mortality rate of patients with MV is very high, despite a significant vari... more Background The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain. Objective The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia. Methods Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region. Results The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36–58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96–18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = ...
Frontiers in Medicine, 2022
Background Cesarean section (CS) has been one of the most frequently performed major surgical int... more Background Cesarean section (CS) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Spinal opioid and abdominal field block have been investigated as effective analgesia for postoperative pain and reduce the need for systemic medications and associated side effects. The aim of the current study is to compare spinal morphine (SM) and bilateral landmark oriented transversus abdominis plane (TAP) block for postoperative pain management. Method In this randomized controlled trial, 114 pregnant mothers scheduled for CS under spinal anesthesia were allocated randomly to receive either SM 0.1 mg (group SM; n = 56) or bilateral landmark-oriented TAP block with 20 ml of 0.25% of bupivacaine (group TAP; n = 52). A comparison of numerical variables between study groups was done using unpaired student t-test and Mann–Whitney test for symmetric and asymmetric data, respectively. Time to event variable was analyzed by using Kaplan–Meir...
Anesthesiology, 2002
Introduction: Patients after major gynecologic surgeries experience moderate to severe pain, whic... more Introduction: Patients after major gynecologic surgeries experience moderate to severe pain, which needs pharmacological intervention. Different regional blocks are now a days introducing as components of multimodal analgesia for pain management. Even though transversus abdominis plane block and paravertebral block were described for postoperative analgesia in abdominal surgeries, data comparing these blocks for gynecologic surgery is limited. Objectives: The aim of this single blind randomized controlled trail was to compare thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in patients underwent gynecologic surgery under general anesthesia. Methodology: Thirty four patients with American society of anesthesiologists physical status I and II, age between 18 and 65 years underwent gynecologic surgery under general anesthesia were randomly allocated in thoracic paravertebral group or transversus abdominis plane block group. Patients' pain intensity with numerical rating score, time to first analgesic time and total rescue analgesic/tramadol consumption were documented by data collectors who were unaware of the block done for the patents during the first 24 ours postoperatively. Results: Time to first analgesic request was lower in thoracic paravertebral group than transversus abdominis plane group but not statistically significant (p ¼ 0.057). Median numerical rating scale score was significantly lower in thoracic paravertebral group than transversus abdominis plane group at post anesthesia care unit admission (p ¼ 0.016). Time taken to perform the block was significantly higher in thoracic paravertebral group than transversus abdominis plane group (p < 0.001). Conclusion: Both thoracic paravertebral block and transversus abdominis plane block were effective for postoperative analgesia in women underwent gynecologic surgery under general anesthesia. Although thoracic paravertebral block appeared to be as effective as transversus abdominis plane block, it took longer time to perform the block.
PLOS ONE
Background Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory d... more Background Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory depression, vomiting, and shivering. The side effects are dose-dependent, therefore different approaches have been attempted to avoid spinal-induced complications including lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids. Objective To compare the Hemodynamic and analgesic effects of intrathecal fentanyl as an adjuvant with low and conventional doses of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia. Methodology An institutional-based prospective cohort study was conducted on 90 patients. Data was collected with chart review, intraoperative observation, and postoperatively patient interview. Data was entered into EPI INFO and transport to SPSS version 23 for analysis of variables using one-way ANOVA, Kruskal Wallis H rank test, and chi-square. Result Hypotension but not bradycardia, was significantly frequent i...
International Journal of Surgery Open, 2020
Procedural sedation and analgesia (PSA) implies the state of drug induced tolerance of uncomforta... more Procedural sedation and analgesia (PSA) implies the state of drug induced tolerance of uncomfortable or painful diagnostic, interventional medical and surgical procedures. Ketofol (ketamine and Propofol mixture) is a good combination of drugs for PSA in painful procedures in pediatrics resulting in hemodynamic and respiratory safety. A combination of these drugs provides sedation, analgesia, and rapid recovery with hemodynamic stability and minimal respiratory depression. The objective of sedation during such procedures is to reduce the discomfort of the patient and to facilitate the performance of the procedure. This systematic review was conducted according to the preferred reporting items for systematic review and meta-analysis protocol (PRISMA). Evidences for this guideline development were searched from PubMed, Google Scholar, Google search, and Medline databases with keywords. During the review of searched literature for the guideline, important concerns discussed were patient...
Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Opt... more Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. Methods Eighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Man...
International Journal of Surgery Open, 2021
Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body... more Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show signi cant bene t and epidural needle and catheter techniques didn't provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety pro les. Methods and materials: After Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student's T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and sher's exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. Result: The overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention(36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the intervention Conclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasible Registration: The protocol was registered prospectively in Clinical Trials.gov (NCT04393766).
Critical Care
Background The global mortality rate of patients with MV is very high, despite a significant vari... more Background The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain. Objective The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia. Methods Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region. Results The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36–58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96–18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = ...
Frontiers in Medicine, 2022
Background Cesarean section (CS) has been one of the most frequently performed major surgical int... more Background Cesarean section (CS) has been one of the most frequently performed major surgical interventions and causes severe postoperative pain. Spinal opioid and abdominal field block have been investigated as effective analgesia for postoperative pain and reduce the need for systemic medications and associated side effects. The aim of the current study is to compare spinal morphine (SM) and bilateral landmark oriented transversus abdominis plane (TAP) block for postoperative pain management. Method In this randomized controlled trial, 114 pregnant mothers scheduled for CS under spinal anesthesia were allocated randomly to receive either SM 0.1 mg (group SM; n = 56) or bilateral landmark-oriented TAP block with 20 ml of 0.25% of bupivacaine (group TAP; n = 52). A comparison of numerical variables between study groups was done using unpaired student t-test and Mann–Whitney test for symmetric and asymmetric data, respectively. Time to event variable was analyzed by using Kaplan–Meir...
Anesthesiology, 2002
Introduction: Patients after major gynecologic surgeries experience moderate to severe pain, whic... more Introduction: Patients after major gynecologic surgeries experience moderate to severe pain, which needs pharmacological intervention. Different regional blocks are now a days introducing as components of multimodal analgesia for pain management. Even though transversus abdominis plane block and paravertebral block were described for postoperative analgesia in abdominal surgeries, data comparing these blocks for gynecologic surgery is limited. Objectives: The aim of this single blind randomized controlled trail was to compare thoracic paravertebral block and transversus abdominis plane block for postoperative analgesia in patients underwent gynecologic surgery under general anesthesia. Methodology: Thirty four patients with American society of anesthesiologists physical status I and II, age between 18 and 65 years underwent gynecologic surgery under general anesthesia were randomly allocated in thoracic paravertebral group or transversus abdominis plane block group. Patients' pain intensity with numerical rating score, time to first analgesic time and total rescue analgesic/tramadol consumption were documented by data collectors who were unaware of the block done for the patents during the first 24 ours postoperatively. Results: Time to first analgesic request was lower in thoracic paravertebral group than transversus abdominis plane group but not statistically significant (p ¼ 0.057). Median numerical rating scale score was significantly lower in thoracic paravertebral group than transversus abdominis plane group at post anesthesia care unit admission (p ¼ 0.016). Time taken to perform the block was significantly higher in thoracic paravertebral group than transversus abdominis plane group (p < 0.001). Conclusion: Both thoracic paravertebral block and transversus abdominis plane block were effective for postoperative analgesia in women underwent gynecologic surgery under general anesthesia. Although thoracic paravertebral block appeared to be as effective as transversus abdominis plane block, it took longer time to perform the block.
PLOS ONE
Background Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory d... more Background Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory depression, vomiting, and shivering. The side effects are dose-dependent, therefore different approaches have been attempted to avoid spinal-induced complications including lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids. Objective To compare the Hemodynamic and analgesic effects of intrathecal fentanyl as an adjuvant with low and conventional doses of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia. Methodology An institutional-based prospective cohort study was conducted on 90 patients. Data was collected with chart review, intraoperative observation, and postoperatively patient interview. Data was entered into EPI INFO and transport to SPSS version 23 for analysis of variables using one-way ANOVA, Kruskal Wallis H rank test, and chi-square. Result Hypotension but not bradycardia, was significantly frequent i...
International Journal of Surgery Open, 2020
Procedural sedation and analgesia (PSA) implies the state of drug induced tolerance of uncomforta... more Procedural sedation and analgesia (PSA) implies the state of drug induced tolerance of uncomfortable or painful diagnostic, interventional medical and surgical procedures. Ketofol (ketamine and Propofol mixture) is a good combination of drugs for PSA in painful procedures in pediatrics resulting in hemodynamic and respiratory safety. A combination of these drugs provides sedation, analgesia, and rapid recovery with hemodynamic stability and minimal respiratory depression. The objective of sedation during such procedures is to reduce the discomfort of the patient and to facilitate the performance of the procedure. This systematic review was conducted according to the preferred reporting items for systematic review and meta-analysis protocol (PRISMA). Evidences for this guideline development were searched from PubMed, Google Scholar, Google search, and Medline databases with keywords. During the review of searched literature for the guideline, important concerns discussed were patient...
Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Opt... more Background Insertion of laryngeal mask airway (LMA) requires an adequate depth of anesthesia. Optimal insertion conditions and hemodynamic stability during LMA insertion are mainly influenced by the choice of the intravenous induction agent. Propofol was recommended as a standard induction agent for LMA insertion. Due to unavailability and cost for treatment Propofol is not easily availed, thus this study aimed at assessing the effect of thiopentone with lidocaine spray compared to Propofol on hemodynamic change and LMA insertion on the patient undergoing elective surgery. Methods Eighty-four participants were followed in a prospective cohort study based on the induction type of either thiopentone-lidocaine group (TL) or Propofol (P). Hemodynamic variables, LMA insertion condition, apneic time, and cost of treatment during the perioperative time were recorded. Data were checked for normality using the Shapiro-Wilk test. Numeric data were analyzed unpaired student's t-test or Man...
International Journal of Surgery Open, 2021
Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body... more Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show signi cant bene t and epidural needle and catheter techniques didn't provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety pro les. Methods and materials: After Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student's T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and sher's exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. Result: The overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention(36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the intervention Conclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasible Registration: The protocol was registered prospectively in Clinical Trials.gov (NCT04393766).