Réveil peropératoire et memorisation: prévalence et aspects cliniques dans un Pays Sub-Saharien

Objective: To study intraoperative memorization in the service of general surgery of Yalgado Ouedroago teaching Hospital (YO-TH) in Burkina Faso. Methods: It was a prospective study in the service of general surgery of YOTH over 7 months. The inclusion criteria were: age ≥ 18 years, absence of psychiatric disorder, American Society of Anesthesiology (ASA) score less than 4, informed consent written. Patients were interviewed at recovery. The questionnaire of Brice et al [8] was used and data were analyzed with SPHINX version 5.0.1 Results: A total of 475 patients were included. The mean age was 40.4 ± 16.3 years. The sex ratio was 1.4. The majority (56%) took psychoactive substance and 78.1% of patients had ASA score 2 or 3. Seven (1.4%) patients reported an explicit perioperative memorization (EPOM +). The mean age of EPOM + patients was 26.8 ± 6.57 years with a sex ratio 1.3. There was difference between EPOM + patients and EMPO - for age (p = 0.0001), occupation (p = 0.009) and antecedent of local anesthesia (p = 0.004). Five patients reported auditory perceptions, four cases of visual perceptions and two tactile perceptions. Pain was the most unpleasant memorization recorded. The psychological consequences of EPOM + were anxiety (2 cases). Conclusion: The frequency of EPOM is low in our context and the main cause was a slight anesthesia

Effect of propofol and etomidate on normoxic and chronically hypoxic pulmonary artery

BACKGROUND: Chronic alveolar hypoxia results in sustained arterial constriction, and increase in pulmonary vascular resistance leading to pulmonary artery hypertension (PAHT). The aim of this study was to investigate the effect of propofol and etomidate on pulmonary artery (PA) reactivity in chronically hypoxic (CH) rats, a model of pulmonary arterial hypertension (PAHT), in normoxic animals, and human PA. METHODS: CH rats were maintained 14 days at 380 mmHg pressure in a hypobaric chamber. Human tissue was retrieved from histological lung pieces from patients undergoing resection for carcinoma. Cumulative concentrations of anaesthetics were tested on isolated vascular rings precontracted with phenylephrine (PHE) or 100 mM KCl. Statistical comparisons were done by ANOVA, followed, when needed, by Student t tests with Bonferroni correction as post-hoc tests. RESULTS: In normoxic rat PA, maximal relaxation (R(max)) induced by etomidate and propofol was 101.3 ± 0.8% and 94.0 ± 2.3%, respectively, in KCl-precontracted rings, and 63.3 ± 9.7% and 46.1 ± 9.1%, respectively, in PHE-precontracted rings (n = 7). In KCl-precontracted human PA, R(max )was 84.7 ± 8.6 % and 66.5 ± 11.8%, for etomidate and propofol, respectively, and 154.2 ± 22.4 % and 51.6 ± 15.1 %, respectively, in PHE-precontracted human PA (n = 7). In CH rat PA, the relaxant effect of both anaesthetics was increased in PHE-precontracted and, for etomidate only, in KCl-precontracted PA. In aorta, CH induced no change in the relaxant effect of anaesthetics. CONCLUSION: Propofol and etomidate have relaxant properties in PA from human and normoxic rat. The relaxant effect is specifically accentuated in PA from CH rat, mainly via an effect on the pharmacomechanical coupling. Etomidate appears to be more efficient than propofol at identical concentration, but, taking into account clinical concentrations, etomidate is less potent than propofol, which effect was in the range of clinical doses. Although these findings provide experimental support for the preferential use of etomidate for haemodynamic stability in patients suffering from PAHT, the clinical relevance of the observations requires further investigation

Incidence and outcome of severe ante-partum hemorrhage at the Teaching Hospital Yalgado Ouédraogo in Burkina Faso

Abstract Background Hemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery. Methods Analytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included. Results During our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia. Conclusion APH is a complication associated with significant maternal and fetal morbidity and mortality

Evaluation de l’état nutritionnel des patients adultes agressés admis en réanimation au Centre hospitalier universitaire Souro Sanou de Bobo-Dioulasso (CHUSS)

L’objectif de cette étude est d’évaluer l’état nutritionnel des « patients agressés » admis dans le service de réanimation polyvalente du CHUSS de Bobo-Dioulasso. L’étude prospective et descriptive a été conduite de juin à décembre 2012 Quarante-huit patients ont été inclus, leur âge moyen était de 37,7 ± 14,7 ans. Le traumatisme crânien grave a constitué la situation d’agression la plus fréquente (58,3 %). La durée moyenne du séjour a été de 13,5 ± 10,6 jours. A l’admission, le taux de dénutrition variait de 18,8 à 37,7 % en fonction des paramètres utilisés. La courbe du taux de variation de la circonférence brachiale présente une corrélation linéaire très forte avec la durée d’hospitalisation (p<0,001), celle de l’albumine a une signification statistique moins forte ; l’évolution du taux de lymphocytes n’était pas modélisable. Les circonférences brachiales moyennes à J4 et J7 étaient significativement plus basses chez les patients dénutris à l’admission que chez ceux qui ne l’étaient pas (p= 0,001). Pour ce qui est de l’albuminémie la différence était significative seulement à J4. Les patients agressés admis en réanimation sont fréquemment dénutris. Cet état s’aggrave rapidement et sévèrement pendant leur séjour hospitalier.Mots-clés : dénutrition, patients agressés, réanimation, Burkina Faso