Glycaemic profile of children undergoing anaesthesia (GLYCANA) at Mercy James Centre in Malawi: an observational study.

BACKGROUND: Hypoglycaemia and hyperglycaemia may develop during anaesthesia and surgery in children and can lead to severe adverse clinical outcomes. No study, as far as we know, has investigated glucose homeostasis in children undergoing surgery in Malawi. The aim of this study was to assess perioperative glucose levels of the children undergoing anaesthesia at Mercy James Centre (MJC) for Paediatric Surgery, Blantyre, Malawi. METHODOLOGY: This was an observational cross-sectional study. We looked at 100 children aged 1 day to 15 years anaesthetised at MJC. Data were analysed using SPSS 28. Student t test and Analysis of the variance (ANOVA) were used to compare means. The level of significance was 5%. RESULTS: Male children represented 68%. The median age was 2.2 years. Sixten percents of patient were underweight. Fasting times were prolonged for 87%. Maintenance IV fluid with 2.5% dextrose was given to 14%. Overall, there was a significant increase of glycaemia from induction of anaesthesia to the end of the procedure. Hypoglycaemia was rare. The mean fasting glycaemia was 99.04 mg/dL ± 1.8, 116.95 mg/dL ± 34.2 at 30 min into the procedure and 127.62 mg/dL ± 46.8 at the end of the procedure. The differences in means were statistically significant (p < 0.001). Prolonged fasting times was associated with lower blood glucose means whereas nutrition status, type of the procedure, addition of dextrose in the fluid, and duration of procedure were associated with higher glycaemia means. CONCLUSION: Glycaemia increases under anaesthesia and surgery. Recommended fasting times, optimising nutritional status, when possible, no dextrose or lower than 2.5% dextrose in IV maintenance fluid are possible strategies to maintain blood sugar homeostasis during paediatric surgery and anaesthesia.

General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo.

BACKGROUND: General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo in the Democratic Republic of the Congo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. METHODS: This was a retrospective descriptive and analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients files, anaesthesia registries and were analysed with SPSS 26. RESULTS: From a total of 921 patients, 539 (58.5%) were male and 382 (41.5%) female patients. A total of 83 (9.0%) patients died representing an overall perioperative mortality rate of 90 per 1000. Out of the 83 deaths, 38 occurred within 24 h representing GA related mortality of 41 per 1000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were: being a neonate or a senior adult, emergency operation, ASA physical status > 2 and a single deranged vital sign preoperatively, presenting any complication during GA, anaesthesia duration > 120 minutes as well as visceral surgeries/laparotomies. Ketamine was the most employed anaesthetic. CONCLUSION: GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, improved infrastructure, better equipment and drugs procurement and considering regional anaesthesia whenever possible.

Practice of standard monitoring during anaesthesia in hospitals of North Kivu: a survey of health facilities of the health antenna of Butembo.

BACKGROUND: Standard monitoring during anaesthesia is a core element of patient safety and practice of safe anesthesia has reduced morbidity and mortality worldwide. The main objective of this study was to assess the practice of standard monitoring during anaesthesia in the hospitals of North Kivu, so as to establish a baseline overview of the situation, and orientate plans towards safe anaesthesia in the region. METHODS: This study was a cross-sectional survey of health facilities of the Health Antenna of Butembo in Democratic Republic of Congo and was conducted from October to December 2018. Questionnaires were brought to anaesthesia providers in the health facilities. The study included 1 answer from the anaesthesia practitioners who accepted to participate. The practices of standard monitoring in the health facilities were compared to WHO-WSFA guidelines. Data was captured and analyzed with Epi Info 7. RESULTS: Forty out of 90 health facilities (44.4%) of 10 health zones responded on the questionnaire. Twenty-three health facilities (57.5%) were from private sector and 17 (42.5%) from public sector. Sixteen health facilities (40.0%) were from the Butembo health zone. The median number of anaesthesia providers was 2 per health facility. Of all the anaesthesia providers, none were physicians, 47.5% were nurses practicing anaesthesia without any training in anaesthesia and 47.5% were nurse anaesthetists. All the health facilities were providing general anaesthesia whereas spinal anaesthesia was provided in 22 out of 40 centers (55%). Seventy percent (28/40) of the facilities were below standard according to WHO-WSFA guidelines. Only 40% (16/40) were using a pulse oximeter and 10% (4/40) declared that ECG was occasionally used. CONCLUSION: The practice of standard monitoring is poor in health facilities of the Health Antenna of Butembo. Efforts should be made to improve monitoring which is a key element of safe anaesthesia.