RESUMO
AIMS: To describe the practice of pediatric anesthesia in the main University Hospitals in Benin. PATIENTS AND METHODS: We conduct a retrospective study involving 512 children at the 'Centre National Hospitalier et Universitaire' and the 'Hôpital de la Mère et de l'Enfant Lagune' in Cotonou. All children less than 15 years of age undergoing surgery from January to December 2007 were included. Patient demographics, anesthetic technique, perioperative monitoring and complications were analyzed. RESULTS: General anesthesia was used in 94% of children. Regional anesthesia was used in 1.7% of children at CNHU and 17% of children at Hôpital de la Mère et de l'Enfant Lagune. Inhalational induction was the commonest technique used. Halothane was the only inhalational agent available for induction. Seventy-two percent of children having general anesthesia were intubated. Muscle relaxation was used in 48% of cases, only with pancuronium. The available perioperative monitoring equipment was not used regularly. All children having general anesthesia breathed spontaneously with manual assistance. There were eight cardiac arrests recorded, giving an incidence of 156 cardiac arrests per 10,000 anesthetics. Hypoxia was the commonest cause of cardiac arrest. The mortality associated with cardiac arrest was very high (62%). There were three prognostic factors that predicted a poor outcome: age <1 year, emergency surgery and an ASA score of three or more. CONCLUSION: Pediatric anesthesia in the two University Hospitals is far from satisfactory. Morbidity and mortality are unacceptably high. Suggestions are made to improve the safety of children undergoing anesthesia.
Assuntos
Anestesia , Anestesiologia/tendências , Países em Desenvolvimento , Pediatria/tendências , Adolescente , Anestesia/efeitos adversos , Anestesia/mortalidade , Anestesia por Condução/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Benin , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Parada Cardíaca/mortalidade , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Intraoperatória , Pediatria/estatística & dados numéricos , Sala de Recuperação , Estudos Retrospectivos , Fatores Sexuais , Recursos HumanosRESUMO
Anesthesia in developing countries deserves special attention. The most common technique is general anesthesia (with spontaneous or manually assisted ventilation). Nonmedical anesthetists with limited training and supervision and lacking the most common drugs and anesthetic equipment administer anesthesia, usually for emergency surgery. There are important safety issues, especially for pediatric anesthesia. Regarding pediatric surgery, the major workload is due to abdominal emergencies, mainly neonatal bowel obstruction or peritonitis due to typhoid perforation. The morbidity and mortality rate for these conditions is high.
Assuntos
Anestesia , Anestesiologia , Países em Desenvolvimento , África Subsaariana , Anestesia/métodos , Anestesia/normas , Anestesiologia/instrumentação , Anestesiologia/normas , Criança , Equipamentos Descartáveis/provisão & distribuição , Reutilização de Equipamento , Humanos , Avaliação de Resultados em Cuidados de Saúde , Recursos HumanosRESUMO
The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication.