Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

[Subtotal sternal agenesis with ectopia cordis: surgical management and long-term outcome (a case in Benin)]. / Agénésie sternale subtotale avec ectopia cordis: gestion chirurgicale et résultat à long terme (à propos d´un cas au Bénin).

Sternal agenesis as well as ectopia cordis are extremely rare congenital malformations. We here report a single case treated in the Department of Paediatric Surgery in Benin. The study involved a 3-year-old girl with congenital sternal agenesis associated with ectopia cordis; firstly, she underwent controlled healing. Then thoracoplasty was performed with favourable outcome. Long-term results are good. Now, she is 13 years old, is attending school and has a satisfactory clinical condition. This is one of the few cases reported in the literature. Optimal therapeutic management has been keeping the patient alive in West Africa.

Morbidité sévère et décès après erreurs médicamenteuses en rachianesthésie

Introduction : Les erreurs médicamenteuses, compte tenu de leur gravité potentielle, constituent un problème des systèmes de santé. Nous rapportons la morbidité sévère et la mortalité liées à l'erreur médicamenteuse lors de rachianesthésies. Méthode : Cette étude rétrospective a été menée au Service d'Aide Médicale d'Urgence (SAMU) du Bénin. Nous rapportons une série de neuf cas de patients ayant présenté une complication d'anesthésie par erreur médicamenteuse au cours d'une rachianesthésie, pendant la période de 2012 à 2017. Les données ont été collectées à partir des registres du SAMU, des rapports d'anesthésie et des dossiers médicaux. Nous avons étudié les caractéristiques sociodémographiques, les circonstances de l'acci-dent, les médicaments en cause, la symptomatologie clinique et paraclinique, les soins administrés et l'évolution des patients.Résultats : Les patients étaient classés en ASA1 ou ASA2. Nous avons noté trois circonstances d'er-reurs médicamenteuses en rachianesthésie : erreurs par confusion d'ampoules et de spécialités, l'er-reur par confusion de seringues avec un mauvais médicament, l'erreur par confusion de seringues avec le bon médicament à une mauvaise concentration. Quatre médicaments ont été en cause : l'acide tra-nexamique, l'atropine, la noradrénaline et la morphine. Pour l'injection accidentelle d'acide tranexa-mique, cette erreur a concerné quatre patientes âgées de 25, 35, 41, 46 ans avec 3 décès. Les injections accidentelles d'atropine et de la noradrénaline ont concerné quatre patientes âgées de 29, 40, 41 ans pour l'atropine et de 26 ans pour la noradrénaline. Le surdosage de morphine a concerné un patient de 83 ans, qui a présenté une dépression respiratoire profonde. Conclusion : Dans cette série d'erreurs médicamenteuses en rachianesthésie, quatre médicaments ont été impliqués. Une morbidité grave et une mortalité lourde ont été observées avec l'acide tranexa-mique en injection intrathécale