[Preoperative psychological experience and beliefs in adult patients scheduled for surgery at the University Hospital of Parakou in Benin]. / Vécu psychologique préopératoire et croyances chez les patients adultes programmés pour une intervention chirurgicale à l'hôpital universitaire de Parakou au Bénin.

OBJECTIVE: To study the preoperative psychological experience and beliefs in adult patients scheduled for surgery at the University Hospital of Parakou. PATIENTS AND METHODS: A descriptive and analytical study with prospective data collection conducted over three months (June 1st to August 30, 2012) and involved 75 patients. RESULTS: Of the 108 patients scheduled for surgery, 75 patients (69.44%) had been chosen. The average age was 44.11±16.24 years with a male predominance (56%). Fifty-five patients (73.3%) were anxious and 32 patients (46.7%) were afraid of dying. Forty-five patients (60%) had not received any information about the procedure they should undergo and 60 patients (80%) were not informed of the possible complications of surgery. Fifty-eight patients (77.3%) were aware of the anesthetic technique and 5.2% of patients were aware of the possible complications of anesthesia. In 56 patients (74.7%), the disease was of natural origin, in 18.6% of cases there was an enchantment and 5 patients (6.7%) the disease is due to a deity. In the context of spiritual care, 15 patients (20%) had consulted a marabout, 11 patients (14.7%) a healer and 10 patients (13.3) a fetish. CONCLUSION: The preoperative period induces a significant burden of anxiety among patients and their families. In Benin, the announcement of surgery is an opportunity for confrontation of the patient to an obsession with death which he manages to escape despite the countless sacrifices of traditional conjuring.

[Anesthesia for upper limb surgery in a developing country: experience of infraclavicular and axillary blocks under neurostimulation]. / Anesthésie pour chirurgie du membre supérieur dans un pays en développement : expérience des blocs infraclaviculaire et axillaire sous neurostimulation.

ABSTRACT: Despite advances in regional anesthesia under ultrasound guidance, neurostimulation remains the primary technique in underequipped locations. MATERIAL AND METHODS: We conducted a prospective descriptive study from January to December 2010 and June 2011 to May 2012 with as our main objective the assessment of the practices of infraclavicular and axillary nerve blocks (ICB and AXB, respectively) at Sylvanus Olympio University Hospital. RESULTS: 105 patients (11.8%) received ICB) and 75 patients (8.5%) axillary blocks (AXB). The average minimum intensity of neurostimulation was 0.4 mA (range: 0.25-0.45 mA. The mean volume of 0.5% bupivacaine used was 30 ± 10 mL. The mean onset time of the block was 15 ± 10 min, and the mean duration of action 6 ± 4 hours. Postoperative pain was significantly worse in patients who received ICB compared to AXB [χ(2) = 19.034, p = 0.00001<0.05]. The cost of either type of locoregional anesthesia under neurostimulation compared with general anesthesia was 44 euros versus 105 euros. CONCLUSION: Peripheral nerve block by ICB and AXB under neurostimulation showed significant difference in terms of postoperative analgesia efficiency. Locoregional anesthesia remains too rarely practiced in underequipped countries despite its benefits and although it is particularly appropriate for these countries.

[Severe differed respiratory depression after intrathecal administration of morphine and clonidine on a 70-year-old patient]. / Dépression respiratoire sévère tardive après administration intrathécale de morphine et de clonidine chez un patient de 70 ans.

We report a case of severe and differed respiratory depression to a 70-year-old patient after spinal anaesthesia for prostatic adenomectomy. Ten milligram of bupivacaine, 30 microg of clonidine and 100 microg of morphine has been administrated intrathecally. The anaesthesia has lasted 4h and, 16h after the induction, the patient had a respiratory depression with bradypnea (5c/min), hypoxia (SpO(2) 80%) and sedation (scale 3 of Wilson). The evolution was favourable after intravenous injection of naloxone and oxygenotherapy. The use of low dose intrathecal morphine can involve a respiratory depression. Intrathecal association of morphine and clonidine must be careful used among old patients and require a monitoring during the first 24h.

[Perioperative morbidity and mortality in a developing country: experience of Lomé teaching hospital]. / Morbidité-mortalité périopératoire dans un pays en développement: expérience du CHU de Lomé (Togo).

OBJECTIVE: New evaluation of early perioperative morbidity and mortality four years after the first study in 2002, at Lomé teaching hospital (Togo). PATIENTS AND METHODS: It was a prospective and descriptive survey during the first semester of 2006. After approval of hospital ethic committee, medical and demographic data, complications and early perioperative deaths have been analyzed. RESULTS: One thousand nine hundred and two anaesthesia was delivered: 58% were women, the average age was 26 years, 94% of patient ASA<3, general anaesthesia (GA) 53% versus regional anaesthesia (LRA): 47%. Spinal anaesthesia (SA) represented 42% of anaesthetic procedures, and emergencies, 56%. 5.49% of complications including 16.16% of deaths were recorded. Death occurred in 69% after GA, and in 60% in the operating room. Seventy percent of patients had cardiovascular complications (five deaths), 30% respiratory failure (six deaths), 11% kidney failures (two deaths). Three deaths were linked to surgery (inadequate management of perioperative haemorrhage). Early perioperative mortality rate was 0.89%. Four cases occurred in the operating room and 12 in intensive care. Deaths were observed often in gynecology and obstetrics (9/16), especially in emergency situations (12/16) and in 75% of cases, patients were ASA>2. Deaths occurred in 13 cases after GA and in three cases after SA. CONCLUSION: This mortality rate was smaller than in 2002. This may be explained by a better prenanaesthetic risk evaluation performed by anaesthetists, the creation of postoperative recovery room, the promotion of regional anaesthesia and the availability of succinylcholine in obstetrics. Significant improvement is still necessary and only be obtained by a national health policy.

[Practice of the thromboembolic disease prophylaxis: a survey among surgeons and anaesthetists in Togo]. / Pratique de la prophylaxie de la maladie thromboembolique veineuse: enquête auprès des chirurgiens et anesthésistes au Togo.

OBJECTIVE: The aim of this study was to analyse the current practice of postoperative venous thromboembolism (VTE) prophylaxis among anaesthetists, nurse anaesthetist and general surgeons in Togo. METHOD: A total of 160 questionnaires were distributed to anaesthetists and surgeons with varying subspeciality interests. RESULTS: One hundred and three (64%) (3 anaesthetists, 51 nurse anaesthetists and 49 surgeons) returned the questionnaire. Of these, 16% thought that VTE was as common in Togo as in the western countries. Selective VTE prophylaxis was used by 78% of the prescriptors. In order of frequency, indications for selective VTE prophylaxis were obesity, increased risk of VTE related to surgery and past medical history of VTE. Orthopaedic surgery, caesarean section and vascular surgery were most frequently considered as high-risk surgery for VTE event. When prophylaxis was indicated, low molecular weight heparin was prescribed by 87% of prescriptors. In most cases, VTE prophylaxis duration was less than a week. In 92% of institutions, there was no written protocol for VTE prophylaxis. VTE-related morbidity was reported by 34% of the prescriptors over the past year, and 30% of these cases were fatal; 60% of the prescriptors observed these complications one week after the surgery. CONCLUSION: The practice of VTE prophylaxis in Togo is not sufficient. It is necessary to promote the training of practitioners, particularly of physicians.

Deaths associated with anaesthesia in Togo, West Africa.

This study attempts to determine the anaesthetic death rate, the causes of deaths and the avoidable mortality rate (AMR) in consecutive cases. The number of anaesthetics given was 1464: 30 cases died within 24 h. The incidence of 24-h perioperative deaths per 100 anaesthetics was 2.57. In all, 50% of deaths were observed in obstetric surgery; 47% of deaths were associated with cardiovascular management, 30% with respiratory management; 93% of deaths were identified as avoidable. The AMR was 1.5% (anaesthetic AMR: 0.75%, administrative AMR: 0.68%, surgical AMR: 0.07%). Insufficient or no blood available is the only factor for administrative AMR.

[Maternal deaths and anesthetics in the Lomé (Togo) University Hospital]. / Mortalité maternelle: implication anesthésique au CHU de Lomée (Togo).

AIM: To assess the results of anesthesia practices in a department particularly inadequately staffed with physicians specializing in anesthesiology. SETTING AND METHODS: This six-month prospective study (from January through June 2002) took place in the anesthesiology/intensive care unit of the obstetrics and gynecology department of Lomé University Hospital Center. A case report file was completed for each patient, and all anesthetics administered in the obstetrical department (labor and delivery room) were recorded and considered. We examined the perinatal deaths among women who underwent surgery. RESULTS: Anesthetics were administered to 318 women during cesarean delivery (306) and uterine scar repair (12). Nearly all patients (98%) were classified in categories 1 or 2 of the ASA physical status classification system (healthy or mild systemic disease). General anesthesia was induced in 95.9% of the women and spinal bloc used for 4.1%. Thiopental was used most often, and certain drugs, including succinylcholine and ephedrine, were not available as needed. Intraoperative monitoring was essentially nonexistent. Emergency situations accounted for 89.6% of these surgical procedures. Of the 16 cases requiring transfusions, an inadequate supply of blood products or the patient's inability to obtain blood was reported in 14 of the cases. Twelve deaths occurred, for a mortality rate among surgical patients of 3.8%. The principal causes of death were respiratory complications of anesthesia and of pregnancy-related toxemia and the unavailability of hypertonic solutions and blood products. CONCLUSION: The results of this survey show that anesthetics play a role in maternal mortality in Togo. Good practice guidelines adapted to this setting must therefore be developed.