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Background Maintaining patent airways is vital in pediatric anesthetic management. Failure to manage and anticipate difficult laryngoscopy (DL) preoperatively is the leading cause of morbidity and mortality. Data on the predictive values of screening parameters in predicting DL are limited in children. Therefore, this study aimed to assess the predictive value of the modified Mallampati test (MMT), upper lip bite test (ULBT), thyromental distance (TMD), and ratio of height to thyromental distance (RHTMD) in predicting DL in children aged 5–12 years at selected Addis Ababa governmental hospitals in Ethiopia. Methods A multicenter cross-sectional study was conducted on 141 elective pediatric surgical patients aged 5 to 12 years selected using a systematic random sampling technique at three governmental hospitals from December 1, 2021, to April 30, 2022. The collected data were entered and analysed by SPSS version 26. Chi-square and Fisher’s exact tests were used to compare categorical variables. The receiver operating characteristic curve analysis was used to compare the accuracy of MMT, ULBT, TMD, and RHTMD against DL. A P value < 0.05 was considered statistically significant. Results The magnitude of DL was 15.6%. MMT has the highest sensitivity (86.4%), specificity (91.6%), and negative predictive value (NPV) (97.3%) compared to other tests. The ULBT also has a high sensitivity (72.7%) and specificity (84%) with comparable diagnostic accuracy (90.8%) with the MMT (P < 0.05). The sensitivity, specificity, positive predictive value (PPV), NPV, and accuracy of TMD were 63.6%, 95.8%, 73.7%, 93.4%, and 82.2%, respectively. The RHTMD has the lowest specificity (63.6%), PPV (22.5%), NPV (91.4%), and accuracy (56.7%) in predicting DL. Conclusion The MMT and ULBT are good screening tests, followed by the TMD in predicting DL, while the RHTMD was the least accurate predictor. Because no single test has 100% predictive value, a combination of screening tests is advised in pediatrics for predicting DL.

Background: Caudal block is the most preferred technique of postoperative analgesia in pediatrics, despite its limited duration of action. Many additives are used to improve the efficacy of caudal blocks, such as opioids or α2 agonists. Recently, there has been increased use of caudal dexamethasone as postoperative analgesia. Objective: To assess the efficacy of adding caudal dexamethasone on bupivacaine for postoperative analgesia in pediatric infra-umbilical surgery. Method: A prospective cohort study design was employed for two equal groups of 30 children aged 1–14 years scheduled for infra-umbilical surgery under caudal bupivacaine; those exposed to dexamethasone (BD) were considered to be the exposed group and those exposed to bupivacaine alone (B) were the non-exposed group. Pain severity, first analgesia request time as well as analgesic consumption were assessed using Mann-Whitney U test for 24 h. Chi-square test was used to analyze the homogenous categorical independent variables between these two groups and a p-value less than 0.05 was considered to be statistically significant. Result: The dexamethasone with bupivacaine group had significant prolonged postoperative analgesia with a median of 915 (650–1,440) minutes compared with 433 (328–555) minutes in the bupivacaine-alone group (p < 0.001). Moreover, the total analgesic consumption was significantly lower in the dexamethasone group with a median total dose of 55 (0–250) mg compared with 402 (95–812) mg in the bupivacaine group with (p < 0.001). Pain score in the dexamethasone group was reduced, being statically significant at 4th, 8th and 12th hrs. Conclusion: Dexamethasone with bupivacaine decreases postoperative pain severity and total analgesic consumption and prolongs the duration of analgesia. Therefore, we recommend the use of caudal dexamethasone with bupivacaine as an effective option for postoperative analgesia. Highlights:

Materials and methods: An institutional-based cross-sectional study was conducted among 359 nondiabetic adult patients who underwent elective surgery at Tikur Anbessa and Nigist Elleni Mohamed Memorial specialized hospitals from January 1 to March 30, 2021. A systematic random sampling technique was used, and quantitative data were collected through interviews and data retrieval from charts using a pretested questionnaire. Both bivariable and multivariable logistic regression analyses were done to evaluate the association between independent and dependent variables. The level of statistical significance was declared at a P-value <0.05. Result: A total of 359 patient data sets were collected with a response rate of 84%. The study revealed that 152 (42%) of the patients developed postoperative hyperglycemia. Postoperative hyperglycemia was statistically associated with age between 41 and 60 [adjusted odds ratio (AOR) = 4.9, 95% CI = 2.5-9.7], age above 60 (AOR = 5.3, 95% CI = 2.36-11.8), dexamethasone use (AOR = 2.65, 95% CI = 1.1-5.9), general anesthesia (AOR = 5.8, 95% CI = 2.5-13.59), combined general-regional anesthesia (AOR = 4.8, 95% CI = 1.9-8.0) were statistically associated with postoperative hyperglycemia. Conclusion:The prevalence of hyperglycemia is higher in the postoperative period. Age, type of anesthesia, type of procedure, dexamethasone use, and duration of surgery were identified as predictive factors.