Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo.

INTRODUCTION: Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. PATIENTS AND METHODS: This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients' records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). RESULTS: We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated (p < 0.05) with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS < 6 (64%), and ISS > 20 (48.9%). CONCLUSION: pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS < 6, and ISS > 20.

[Epidural analgesia in 20 parturients at the Sylvanus Olympio University Hospital Center in Lomé (Togo)]. / Pratique de l'analgésie péridurale auprès de 20 parturientes au Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo).

We conducted a prospective and descriptive study on epidural analgesia (EA) at the Sylvanus Olympio University Hospital Center in Lomé from February to June 2014. After taking consent from pregnant women selected by simple random sampling and in the absence of contraindication for anesthesia (pre-anesthetic assessment performed in their 8th month of pregnancy), women were enrolled. Out of 29 selected women, 20 (69%) underwent EA. The average age was 30.6 ± 6.6 years: primiparas 35%, multiparas 50%, Obese women (BMI> 30)25%. Average number of punctures: 1.2 ± 0.5; blood reflux into the catheter: 5%; dural puncture: 0. Delay for anesthesia induction: 8.5 ± 2, 2mn. Mean dosage of 0.125% isobaric bupivacaine: 28.8 ± 8ml; digital scale at T10min <3 for all parturient women. Motor block: 0. Hypotension: 1 case (5%). Mode of delivery: vaginal births 19 (95%), cesarean section 1 (5%). Respiratory distress in the newborn: 0. Level of satisfaction: 9,8 ± 0.5 / 10. Sylvanus Olympio University Hospital Center in Lomé provides obstetric EA. While awaiting its availability to all parturient women based on human and material resources, the use of epidural analgesia in the presence of medical indications would be a first step.

[Anesthesiological aspects and complications of intracranial meningiomas operated at the Sylvanus Olympio University Hospital Center, Lomé: about 21 cases]. / Les méningiomes intracrâniens opérés au CHU Sylvanus Olympio de Lomé: aspects anesthésiologiques et complications à propos de 21 cas.

This study aimed to point to both the anesthesiological aspects and the perioperative complications of intracranial meningiomas operated at the Sylvanus Olympio University Hospital Center, Lomé. We conducted a retrospective study by reviewing the medical records of patients with intracranial meningiomas undergoing surgery over the period December 2010-December 2015 (5 years) at the Sylvanus Olympio University Hospital Center, Lomé. Out of 46 patients operated fo brain tumors, 21 (45.6%) had meningioma. The average age was 49 ±20 years, with a male predominance (52.4%) and a sex ratio (M/F) of 1.1. Patients were classified according to ASA classification: 16 patients were classified as ASA II, 4 patients as ASA III and 1 patient as ASA IV. Patients underwent total intravenous anesthesia using hypnotic agent such as propofol (100%) and fentanyl (76.2%), which was the most available opioid. Perioperative complications were: bleeding, (mean blood loss: 1750 ±584 ml), hypotension (mean arterial pressure (MAP) < 60 mmHg) in 10 (47.6%) patients; hemorrhagic shock in 2 (9.5%) patients, cardiovascular arrest: 01 (4.7%) patient successfully resuscitated. Postoperative complications were: convulsions in 5 (23.8%) cases, hyperthermia in 4 (19%) cases, hemorrhagic shock in 2 (9.5%) cases, death in 2 (9.5%) cases. Perioperative morbidity and mortality associated with intracranial meningioma surgery at the Sylvanus Olympio University Hospital Center, Lomé remains high. Improvement of technical equipment and early consultation should reduce these complications.

Post-operative pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Togo.

BACKGROUND: The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. PATIENTS AND METHODS: A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 January to 30 June 2012. Data collected include: demography, type of surgery, American Society of Anaesthesiologists (ASA) classification, anaesthetic protocol, analgesia technique, post-operative complications and cost of analgesia. RESULTS: The study includes 106 post-operative children. Abdominal surgery was performed in 41.5% and orthopaedic surgery in 31.1%. A total of 75% of patients were classified ASA 1. General anaesthesia (GA) was performed in 88%. Anaesthetists supervised post-operative care in 21.7% cases. Multimodal analgesia was used in every case and 12% of patients received a regional block. The most frequently unwanted effects of analgesics used were nausea and/or vomiting in 12.3%. At H24, child under 7 years have more pain assessment than those from 7 to 15 years (46% vs 24%) and this difference was statistically significant (chi-square = 4.7598; P = 0.0291 < 0.05). The average cost of peri-operative analgesia under loco regional analgesia (LRA) versus GA during the first 48 h post-operative was US $23 versus $46. CONCLUSION: Our study showed that post-operative pain management in paediatric surgery is often not well controlled and paediatric loco regional analgesia technique is under practiced in sub Saharan Africa.