Anesthesie au cours des ventriculocisternostomies au Mali : Une serie de 31 cas

Introduction La ventriculocisternostomie est une technique moderne du traitement des hydrocéphalies. Elle est peu fréquente en Afrique. Objectif:  Décrire la prise en charge anesthésique et l’évolution des patients opérés par ventriculocisternostomie. Patients et Méthode: Etude de cohorte prospective de 15 mois de janvier 2014 au 31 mars 2015. La saisie et l’analyse des données ont été effectuées par Microsoft word 2010 Epi info 3.5.3.fr. Résultats:  Les nourrissons prédominaient avec un sexe ratio de 1,81 en faveur du sexe masculin. Un antécédent de méningite ou d’infection respiratoire à répétition a été retrouvé chez 10 patients (32,2%). L’indication de la ventriculocisternostomie était une hydrocéphalie chez 30 patients (96, 8%). La classe ASA était II chez 19 patients (61,3%). L’intubation était prévue difficile chez 28 patients (90,3%).Tous les patients ont été opérés sous anesthésie générale. Une antibioprophylaxie a été faite chez tous les patients. La tachycardie isolée a été le seul évènement indésirable per opératoire observé chez 13 patients (41,9%). La durée de la chirurgie était de 62, 25 ± 20,9 minutes celle de l’anesthésie était de 93,5 ± 25,4 minutes. En postopératoire, une complication a été observée chez 7 patients (22,6%). Il s’agissait d’une méningite chez 3 patients (42,9%), d’une souffrance cérébrale, d’une obstruction de la stomie, d’un abcès cérébral et une paralysie du nerf III dans 14,3% chacune (1 patient). L’évolution était favorable chez 29 patients (93,5%). La durée médiane d’hospitalisation était de 3 jours. Conclusion:  Au Mali, la prise en charge anesthésique au cours de la ventriculocisternostomie s’adresse à une population pédiatrique avec un terrain précaire.   English title: Anesthesia during endoscopic third ventriculostomy in Mali: A series of 31 cases Introduction: Endoscopic Third Ventriculostomy (ETV) is a modern technique for the treatment of hydrocephalus. It is uncommon in Africa. Objective To describe ananesthesic management and the outcome of patients operated on by ETV. Patients and Methods Prospective cohort study over 15 months to January 2014 at 31 march 2015. The data entry and analysis were done by word office, Epi info 3.5.3.fr. Results: Infants predominated with a sex ratio of 1.81 in favor of men. A history of meningitis or recurrent respiratory infection was found in 10 patients (32.2%). The indication of ETV was hydrocephalus in 30 patients (96.8%). The ASA class was II in 19 patients (61.3%).  Intubation was expected to be difficult in 28 patients (90.3%). All patients were operated on under general anesthesia. Antibiotic  prophylaxis was done in all patients. Isolated tachycardia was the only peroperative adverse event observed in 13 patients (41.9%). The duration of the surgery was 62.25 ± 20.9 minutes that of the anesthesia was 93.5 ± 25.4 minutes. Postoperatively, a complication was observed in 7 patients (22.6%). It was meningitis in 3 patients (42.9%), brain pain, obstruction of the stoma, brain abscess and nerve III paralysis in 14.3% each (1 patient). The outcome was favorable in 29 patients (93.5%). The median hospital stay was 3 days. Conclusion:  In Mali, anesthetic management during ETV is aimed at a pediatric population with precarious terrain

Anesthesiology of Emergency Caesarean Section at Gabriel Toure CHU

Introduction: The aim of this study was to evaluate the anesthesiological management of emergency caesareans at the CHU Gabriel TOURE. Methodology: This was a prospective study that took place at the CHU Gabriel TOURE in the Anesthesia Resuscitation department and in the operating theater of the Gyneco-Obstetrics department from August 01 to October 31, 2021. It concerned all caesarean sections performed in the Gyneco-Obstetrics department of the CHU Gabriel TOURE during a period of three months. All patients who came urgently to the Gyneco-Obstetrics department during the study period with an indication for emergency caesarean section Patients operated for emergency caesarean in another center were not included: caesareans performed outside our study period, planned caesareans, ruptured GEU (ectopic pregnancy), haemostasis hysterectomy. The information obtained from the patients and in the prenatal consultation book is compiled on an individual data collection sheet on which the variables to be studied appear. Statistical analysis was performed using SPSS version 25 software. Microsoft Word software was used for word processing. Results: During the study period, we performed 168 emergency cesarean sections out of 389 cases of cesarean section, i.e. a frequency of 43.18%. Conclusion: The practice of emergency obstetric anesthesia poses organizational difficulties, linked to the absence of a post-operative monitoring room, information from the anesthesia team and availability of products. PRH was the most frequent surgical indication; for this reason, GA has been the most practiced technique. Many patients were transferred to intensive care, i.e. 38.69% of cases and we recorded 38.69% of complications.</jats:p

Prise en charge anesthésiologique des abdomens aigus chirurgicaux chez l’adulte au département d’anesthésie réanimation et de médecine d’urgence du CHU Gabriel Toure.

The anesthesiological management of acute surgical abdomens remains a delicate exercise for anesthesiologists and resuscitators, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the dysfunction of the emergency departments with which they are confronted. The objectives of this work were to study clinical and anesthesiological aspects, as well as intraoperative morbidity and mortality related to acute surgical abdomens. We conducted a prospective 12-month study. In this study was included Any patient received in the emergency room of the C.H.U Gabriel Touré in whom the diagnosis of acute surgical abdomen had been retained on the basis of clinical and paraclinical signs who agreed to participate. Results: During our study period, acute surgical abdomens represented 631/1335 cases of all emergency surgeries. Fifty-six of them were referred to intensive care immediately after surgery. Peritonitis represented 376 cases (61%) followed by intestinal obstruction (135/631), appendicitis (76/631) and hemoperitoins (33/631). The clinical presentation on admission was dominated by signs of hypovolemic and infectious delay. The average hemoglobin level was 12.03g / dl. Renal impairment (clearance &lt;50 ml / ml) was detected in 50 patients. The mean operating time was 134.32 min regardless of the diagnosis. In the intensive care group, the reason for admission was dominated by states of shock 24 out of 56 cases (i.e. 42.9%), delayed awakening 5/56 cases, bronchial inhalation 4/56, cardio circulatory arrest 2/56 . In this group 14 patients received artificial ventilation ≥12h. Vasoactive support coupled with macromolecular filling was required in 17/56 cases. Eleven patients were reoperated x 25 during their stay in intensive care. The major postoperative complications were septic shock in 11 cases, hemorrhagic shock in 6 cases and 1 cardiogenic shock. The overall mortality from acute surgical abdomens was 2.24% patients (30 patients). Conclusion: The management of abdominal surgical emergencies must be multidisciplinary in order to further reduce the morbidity and mortality rate which remains significant today.                                                                                                                                &#x0D; Keywords: Anesthesia, perioperative, abdominal surgical emergency, Gabriel Touré University Hospital</jats:p