2 research outputs found
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: DĂ©crire la prise en charge anesthĂ©sique et lâĂ©volution des patients opĂ©rĂ©s par ventriculocisternostomie.
Patients et MĂ©thode: Etude de cohorte prospective de 15 mois de janvier 2014 au 31 mars 2015. La saisie et lâanalyse des donnĂ©es ont Ă©tĂ© effectuĂ©es par Microsoft word 2010 Epi info 3.5.3.fr.
RĂ©sultats: Les nourrissons prĂ©dominaient avec un sexe ratio de 1,81 en faveur du sexe masculin. Un antĂ©cĂ©dent de mĂ©ningite ou dâinfection respiratoire Ă rĂ©pĂ©tition a Ă©tĂ© retrouvĂ© chez 10 patients (32,2%). Lâindication de la ventriculocisternostomie Ă©tait une hydrocĂ©phalie chez 30 patients (96, 8%). La classe ASA Ă©tait II chez 19 patients (61,3%). Lâintubation Ă©tait prĂ©vue difficile chez 28 patients (90,3%).Tous les patients ont Ă©tĂ© opĂ©rĂ©s sous anesthĂ©sie gĂ©nĂ©rale. Une antibioprophylaxie a Ă©tĂ© faite chez tous les patients. La tachycardie isolĂ©e a Ă©tĂ© le seul Ă©vĂšnement indĂ©sirable per opĂ©ratoire observĂ© chez 13 patients (41,9%). La durĂ©e de la chirurgie Ă©tait de 62, 25 ± 20,9 minutes celle de lâanesthĂ©sie Ă©tait de 93,5 ± 25,4 minutes. En postopĂ©ratoire, une complication a Ă©tĂ© observĂ©e chez 7 patients (22,6%). Il sâagissait dâune mĂ©ningite chez 3 patients (42,9%), dâune souffrance cĂ©rĂ©brale, dâune obstruction de la stomie, dâun abcĂšs cĂ©rĂ©bral et une paralysie du nerf III dans 14,3% chacune (1 patient). LâĂ©volution Ă©tait favorable chez 29 patients (93,5%). La durĂ©e mĂ©diane dâhospitalisation Ă©tait de 3 jours.
Conclusion: Au Mali, la prise en charge anesthĂ©sique au cours de la ventriculocisternostomie sâadresse Ă une population pĂ©diatrique avec un terrain prĂ©caire.
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
Assessment of lung injury severity using ultrasound in critically ill COVID-19 patients in resource limited settings
Abstract Background Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. Methods We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. Results The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound scoreâ<â3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23â±â5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of â 0.38, pâ<â0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patientsâ age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. Conclusion Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality