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Background: Following surgery, neuromuscular paralysis is no longer needed, its action could be quickly and effectively terminated. However, evidences shown that NMBAs often continues in the PACU, even after the administration of acetylcholinesterase inhibitor. Hence, stratifying risks of patients and developing evidence-based guidelines are required by rationalizing residual neuromuscular block preventive strategies in resource limiting setup. Methods: Preferred reporting items for systematic reviews and meta-analyses protocol was used to conduct this review. PubMed, Google Scholar, and Cochrane Library data bases were used to find evidences that helps to draw recommendations and conclusions. Discussion: The incidence of residual neuromuscular block is high in aged, female, and hypothermic patients. Full recovery of neuromuscular block may require 15–30 min after administration of anticholinesterase. Conclusions: Undetected neuromuscular block following the administration of NMBAs is still a common problem in today's anesthesia care. A residual neuromuscular block is a preventable anesthetic complication by application of simple measures like the timing of reversal, appropriate assessment of patient and surgery specific usage of NMBAs. Highlights:

Unplanned postoperative critical care admission poses a potential risk to patients and places unanticipated pressure on clinical services and it has become an important parameter to assess patient safety in perioperative services. This study was aimed to determine the incidence of unplanned intensive care unit admission following surgery and the associated factors. A multi-center cross-sectional study was conducted on postoperative patients admitted to the ICU of three hospitals located in the Amhara region. Data were collected via a structured survey tool and analyzed using SPSS version 23 software with binary logistic regression analysis. The statistical significance to identify patient, anesthetic and surgical related factors in the preoperative, intraoperative, and postoperative period was < 0.05 for multivariable regression with a 95% confidence interval. Predominantly patients were admitted to the ICU in an unplanned manner. ASA status, preoperative hemoglobin (Hgb) level, intraoperative estimated blood loss, and adverse events occurring in the operating room were significantly associated with intensive care unit admission following surgery. Patients who had a low preoperative Hgb value were 35.1 times more likely to be admitted to the intensive care unit in an unplanned manner compared with their counterparts [(Adjust odds ratio (AOR) 35.16; CI 12.82, 96.44)]. Patients with ASA II and III were 19.4 and 16.2 times more likely to be admitted to ICU in an unplanned way compared to patients who had ASA I physical status [(AOR 51.79; CI 8.28, 323.94) (AOR 67.8 CI 14.68, 313.53)]. Unplanned ICU admission after surgery was high in this study, suggesting poor perioperative planning, risk stratification, and optimization of patients.

Background Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia. Methods A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout. Results Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists ( p = 0.01), and were associated with less years of anesthesia experience ( p < 0.001), consuming >5 alcoholic drinks per week ( p = 0.02), and parenthood ( p = 0.01). Conclusion We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced.

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