Réaction à Mohamed Said Nakhli et al. à propos de l'article: "Quand le bloc axillaire reste la seule alternative chez un enfant de 5 ans". The Pan African Medical Journal. 2015;21:36

Le bloc axillaire chez l'enfant est une technique facile et recommandée chez l'enfant. Sa réalisation chez un enfant présentant une hépatite A aigue n'est pas démunie de risques surtout lorsqu'il est associé à une sédation au propofol avec du remifentanil. De même, la présence d'un kyste hydatique unique laisse la possibilité de l'anesthésie générale avec ventilation uni pulmonaire.Mots clés: Bloc axillaire, anesthésie générale, hépatite A, kyste hydatiqueEnglish Title: Reaction to Mohamed Said Nakhli et al. concerning the article: "When the axillary block remains the only alternative in a 5 year old child". The Pan African Medical Journal. 2015;21:36English AbstractAxillary block is an easy and recommended technique in children. Its use in children with acute hepatitis A is not risk free especially when associated with sedation using remifentanil and propofol. Similarly, the presence of a single hydatid cyst allows general anesthesia with mono-pulmonary ventilation.Keywords: Axillary block, general anesthesia, hepatitis A, hydatid cys

Near-infrared spectrometry in pregnancy: progress and perspectives, a review of literature

Near-infrared spectroscopy (NIRS) allows continuous noninvasive monitoring of in vivo oxygenation in selected tissues. It has been used primarily as a research tool for several years, but it is seeing wider application in the clinical arena all over the world. It was recently used to monitor brain circulation in cardiac surgery, carotid endarteriectomy, neurosurgery and robotic surgery. According to the few studies used NIRS in pregnancy, it may be helpful to assess the impact of severe forms of preeclampsia on brain circulation, to evaluate the  efficacy of different treatments. It may also be used during cesarean section to detect earlier sudden  complications. The evaluation of placental function via abdominal maternal approach to detect fetal growth restriction is a new field of application of NIRS.Key words: Near-Infrared Spectrometry, pregnancy, preeclamsia, cesarean sectio

The analgesic effect of clonidine as an adjuvant in dorsal penile nerve block

Introduction: Dorsal penile nerve block (DPNB) is a commonly performed regional anesthetic technique for male circumcision. The aim of this study was to assess the analgesic effect of the adjunction of clonidine to bupivacaine 0.5% in this block. Methods: It was a prospective randomized double-blind clinical trial including 40 ASA1 boys aged from 1 to 4 years undergoing elective circumcision. Dorsal penile nerve block was performed under general Anesthesia. Patients were randomized in two groups: Group 1 (G1) : received 0.1 ml/Kg of bupivacaine 0.5 %with 1μg/kg of clonidine in each side. Group 2 (G2): received 0.1 ml/kg of bupivacaine 0.5 % with placebo in each side. The failure of the DNPB was defined by the increase of heart rate by more than 25% comparing to baseline and in his case an intravenous injection of 20 μg/kg of alfentanyl was given. Post-operative pain was assessed by CHEOPS score. Results: A total of 40 patients were enrolled. Demographic parameters were similar in both groups. We noted no case of DNPB failure in this study. The supply for additional analgesia was seen in 12 patients in group 2 versus 3 cases in group 1. CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) was significantly lower in group 1 from 2nd post operative hour until the 24th hour. Conclusion: Clonidine can be used in dorsal penile nerve block to improve and to prolong its analgesic effects after male circumcision.Pan African Medical Journal 2016; 2

Réhabilitation précoce post césarienne: enquête de pratique auprès des maternités de la région de Sfax en Tunisie

Introduction: Bien que la plupart des principes de réhabilitation précoce post césarienne paraissent applicable dans nos structures de soins, il semble que la mise en oeuvre reste limitée. Méthodes: Il s'agit d'une enquête structurée par courrier électronique auprès des médecins anesthésistes de la région de Sfax décrivant leurs pratiques habituelles dans les maternités étatiques et privées de la région de Sfax. Nous avons utilisé un questionnaire dans le cadre de prise en charge de la césarienne programmée. Résultats: Le taux de réponse des médecins était de 68% (30/44). L'analgésie orale a été débutée au cours des 24 premières heures par 13% des anesthésistes. La perfusion post opératoire a été arrêtée avant 24h dans 27% des cas. Le Retrait de la sonde < H6, la reprise des boissons < H6, la reprise de l'alimentation < H12 ont été observé respectivement dans 57%, 63% et 30% des cas. L'emploi d'ocytocine limité à H6 est la conduite de 60% des médecins interrogés. La carbétocine est encore non utilisée. Conclusion: Les différents composants de la réhabilitation précoce post césarienne sont encore insuffisamment mis en oeuvre.Pan African Medical Journal 2016; 2

Golden hour for fibrinogen concentrate infusion to improve post partum hemorrhage

ON APPEAL FROM THE FOURTH CIRCUIT COURT, UTAH COUNTY, OREM DEPARTMENT HONORABLE ROBERT J. SUMSION Circuit Judg

Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally

The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications.Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (P<0.05). Side effects such as respiratory depression, vomiting and bradycardia were similar in both groups. The adjunction of clonidine to fentanyl as additives to bupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures. The Pan African Medical Journal 2016;2

Predictors of postoperative mortality among neonates after major-risk surgery: A one-year experience from a Tunisian hospital

Background: Neonatal surgery in developing countries remains a high-risk modality p and its outcomes depend on various patient-related, system-related, and management-related factors. This study aims to describe our experience in managing newborns requiring surgical interventions and to investigate the primary predictors of postoperative mortality. Methods: In this observational study, we included all newborns aged less than 28 days who underwent surgery in the pediatric surgery department under general anesthesia with tracheal intubation for major-risk surgery. Patients were categorized into two groups based on the outcome (survival or death) during the two months following surgery. Following a comparison of the two groups, univariable and multivariable logistic regression analyses were conducted to explore predictors of perioperative mortality among neonates. Results: Sixty-seven newborns were included in this study, with an early mortality incidence of 28.3%. Anesthesia management did not impact neonatal mortality. The main predictors of neonatal mortality were revision surgery [aOR=35.5; 95% CI: 1.33- 94.1], surgery duration ≥ 120 minutes [aOR=36.5; 95% CI: 1.48- 312], preoperative mechanical ventilation [aOR=3.88; 95% CI: 1.12- 30.8], and the occurrence of perioperative adverse events [aOR=5.7; 95% CI: 1–29.5] or postoperative surgical complications [aOR=32.5; 95% CI: 1.05–101]. Conclusion: The early mortality rate after major neonatal surgery remains high in our department. It appears that preoperative poor conditions can elevate the risk. Additionally, major-risk surgeries requiring prolonged procedures and revision surgery, along with the incidence of postoperative infections, significantly increase the risk of neonatal mortality