ABSTRACT
With the availability of modern workstations and heightened awareness of the Health services cost and environmental effects of waste anaesthesia gases, anaesthesia providers worldwide are practicing low flow anaesthesia. In most developing countries Low Flow Anaesthesia is still underutilized due to lack of monitoring equipments and sufficient knowledge. Tanzania appears to have a paucity of studies on the prevailing practice pattern of fresh gas flow. Objective; The study aimed at assessing the practice of low flow anaesthesia and volatile agents choices among anaesthesia providers at Muhimbili national hospital and Muhimbili orthopaedic institute. Methods: A descriptive cross-sectional study was carried out for a period of 8 months involving 158 anaesthesia providers. A Structured questionnaire was used to collect data which included demographic, practice setting of Low Flow Anaesthesia, Workstations, scavenging, monitoring equipments, Volatile agents routinely used and preferred Agent. Data were analysed using the IBM Statistical package for social science’s version 23.0. Result: Prevalence of Low flow anaesthesia was 27.2%, however, only 6% used the fresh gas flow of 1l/min – 500mls/min. All anaesthesia providers had workstations and only 2.3% displayed Minimum Alveolar concentration (MAC), 79.1% worked in theatre with functioning scavenging systems, 55.8% used capnography, 6.9% monitored inspiratory Oxygen and none of anaesthesia providers used Bispectral and Agent Analyzers. Isoflurane was the most routinely used inhalational agents (100%) followed by Sevoflurane (69%), then Halothane (32%). Desflurane still not available in these hospitals. Conclusion: Low flow anaesthesia is seldom practiced in our locality despite having strong evidence of attractive advantages in medical practice and ergonomics.

ABSTRACT
Background: Nutritional support in critically-ill patients is one of the most important parameters guarding the prognosis and influencing morbidity and mortality in these patients, owing to that fact, accurate measurement of the resting energy expenditure using Indirect calorimetry is recommended by guidelines as a gold standard. But due to lack of resources and other technicalities predictive equations are conveniently used as surrogates. Aims: This study was intended to examine the extent of malnutrition, poor nutrition support practices and to validate the common used predictive equations in critically-ill patients in our setting. Methodology: A hospital-based descriptive cross-sectional study was conducted on consecutively sampled 110 mechanically ventilated ICU patients at Muhimbili National Hospital Mloganzila. Anthropometric measurements, duration of stay in ICU, Temperature and Minute Volumes were recorded so as to estimate resting energy expenditure, REE from different predictive equations. Using Indirect Calorimetry Module patient’s REE was measured and recorded then a statistical data analyzed using SPSS software version 23. Results: The prevalence of poor nutritional support was 69%; underfeeding and overfeeding were observed in 41.8% and 27.3% of all participants respectively. Prevalence of malnutrition was 51.8%; underweight and overweight were found to be in 29.1% and 22.7% of all participants respectively. The accuracy of predictive equation in ±10% difference was 30%, 45.5%, 46.4% and 68.2% in HB, MSJ, ESPEN and PENN respectively. Conclusion and Recommendation: Malnutrition and Poor Nutritional support are common problems in ICU. Predictive equations have poor accuracy and validity in comparison to indirect calorimetry. Penn State Equation was the most accurate and with the highest agreement with IC.

ABSTRACT
Background: Postoperative period is a time of significant physiological flux, patient recover from the acute derangements resulting from anaesthesia and surgery. On arrival at PACU, the patient is re-evaluated by the anaesthesia provider gives a handover to the responsible PAC provider. Incomplete handover increase risk of morbidity and mortality to patients. Objective: Study assessed the handover practice of postoperative patient from operating room to post-anaesthesia care unit in Muhimbili Orthopedic Institute operating theatre recovery room. Methodology: This was a hospital based cross-sectional observational study which was conducted at Muhimbili Orthopedic Institute Hospital located at Upanga. Handover conducted by Anaesthetic Provider to PACU nurse in the Recovery rooms were Observed and information communicated were marked using SBAR handover checklist. Then anaesthetic providers and PACU nurse were surveyed to know which item in the checklist was relevant to be communicated during handover. Data collected was analyzed using Statistical Package for Social Scientists (SPSS version 23). Results: 319 PACU handover were observed. 17.5% of the handover were completed and rated as Good, 50.8% were satisfactory and 31.7% poorly completed. Most communicated items were Vital Sign 90.6%, Operation Underwent 86.8% and Type of anaesthesia 85.9% and the least was ASA 24.5%. Items providers thought should be communicated were Name of the patient (0.954), Age and Gender (0.938), Type of Anaesthesia (0.925). Among the Anaesthetic Provider Cadre Physician Providers provided Good and Satisfactory handover compared to Nurse Provider. Conclusion: Majority of the handover were satisfactorily completed, with Vital Sign, type of anaesthesia and Operation underwent being the most communicated items in checklist.