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Kabey AKA, Lubanga M, Tshamba M, Kaut M, Kakambal K, Muteya M, Manzanza K, Kalal K. [Anesthesia practice in Lubumbashi: indications, types of surgery and patient types]. Pan Afr Med J 2015; 21:240. [PMID: 26523180 PMCID: PMC4607966 DOI: 10.11604/pamj.2015.21.240.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/20/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Cette étude a pour objectif de décrire la pratique anesthésique dans un pays à faible revenu et où le plateau technique anesthésique est moins équipé. Méthodes Une étude descriptive transversale a été menée durant l'année 2013. L'enquête a concerné les pratiques anesthésiques, les indications chirurgicales et les caractéristiques des malades. L'encodage et l'analyse des données ont été réalisées grâce aux logiciels Epi Info 3.5.3 et Excel 2010. Résultats Nous avons enregistré 2358 patients dont l’âge médian était de 29 + 15 ans, avec 81,5% âgés de 11 à 50 ans. Parmi eux, 67,3% des malades étaient du sexe féminin. Dans ensemble, 62,5% de ces patients étaient pris en charge pour les interventions programmées. L’évaluation du risque anesthésique a montré que 91,9% des patients étaient de la classe ASA I et II. La chirurgie la plus pratiquée était viscérale (46,7%) suivie de la chirurgie gynéco-obstétricale (29,2%). Les différents types d'anesthésie étaient les suivants: anesthésie générale (87,6%), locorégionale (11,8%) et combinée (0,6%). Conclusion La pratique anesthésique dans la population d’étude était dominée par l'anesthésie générale. Les malades étaient au trois quart de sexe féminin et de la classe ASA I et II. Les résultats de cette étude indiquent la nécessité d’évaluer l'issue de cette pratique. La pratique anesthésique à Lubumbashi est tributaire du plateau technique, des compétences du personnel et de l'acceptabilité du type d'anesthésie par les patients.
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Affiliation(s)
- Alain Kabey A Kabey
- Faculté de Médecine, Service d'Anesthésie et Réanimation, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | | | - Mundongo Tshamba
- Faculté de Médecine, Département de Santé Publique, Université de Lubumbashi, République Démocratique du Congo
| | - Mukeng Kaut
- Faculté de Médecine, Département de Santé Publique, Université de Lubumbashi, République Démocratique du Congo
| | - Kaij Kakambal
- Faculté de Médecine, Département de Santé Publique, Université de Lubumbashi, République Démocratique du Congo
| | - Manika Muteya
- Faculté de Médecine, Service d'Anesthésie et Réanimation, Cliniques Universitaires de Lubumbashi, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Kilembe Manzanza
- Faculté de Médecine, Département d'Anesthésie Réanimation, Université de Kinshasa, République Démocratique du Congo
| | - Kapend Kalal
- Faculté de Médecine, Département de Médecine Interne, Cliniques Universitaires de Lubumbashi, République Démocratique du Congo
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Abstract
Neonates are the most vulnerable age group in terms of anesthetic risk and perioperative mortality, especially in the developing world. Prematurity, malnutrition, delays in presentation, and sepsis contribute to this risk. Lack of healthcare workers, poorly maintained equipment, limited drug supplies, absence of postoperative intensive care, unreliable water supplies, or electricity are further contributory factors. Trained anesthesiologists with the skills required for pediatric and neonatal anesthesia as well as basic monitoring equipment such as pulse oximetry will go a long way to improve the unacceptably high anesthetic mortality.
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Affiliation(s)
- Adrian T Bösenberg
- Department Anesthesiology and Pain Management, Faculty Health Sciences, University Washington, Seattle, WA, USA
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Racioppi L, Maurice-Tison S, Tafer N, Phantaly O, Sisuraj A, Favarel-Garrigues JF. Impact of a long specialized training in anaesthesia on the quality of care in a developing country: experience in Laos. ACTA ACUST UNITED AC 2010; 29:e105-14. [PMID: 20347560 DOI: 10.1016/j.annfar.2010.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 01/13/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Assess the impact on the quality of practices in a developing country (Lao Democratic People's Republic) of a long specialized course in anaesthesia (Certificate of Specialized Studies in Anesthesia-Intensive care and Emergency Medicine [Cesarmu]) versus accelerated trainings. POPULATION AND METHOD Study concerned all surgical hospitals and all anaesthesiologists of Lao PDR. At hospital level, the quality of care was assessed and compared between hospitals with and without Cesarmu anaesthetists by using the quality of anaesthesia record and the spinal anaesthesia frequency in lower gyneco-obstetrical surgery. On an individual level, we assessed and compared anaesthetists who were Cesarmu trained and those who were not by using theoretical and practical scores. The latter were acquired by observing complete perisurgical care (pre-, per- and postoperative practical scores). RESULTS We visited 29 of the 34 surgical hospitals in Lao PDR and met 90 of the 111 anesthesiologists. At hospital level, quality criteria were higher in the group of hospitals with Cesarmu anaesthesiologists without that difference being significant. On the other hand, all individual scores measured were significantly higher in the Cesarmu group. DISCUSSION The improvement of practices resulting from training was obvious at the individual level but its impact at hospital level was not significant. There were most likely not enough trained anaesthetists to significantly influence practices in their departments. CONCLUSION According to the criteria used, the impact of Cesarmu on the quality of anaesthesia in Lao PDR seems positive. However, training needs to be continued and practices homogenized.
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Affiliation(s)
- L Racioppi
- Service d'anesthésie-réanimation I, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Ouro-Bang'na Maman AF, Kabore RAF, Zoumenou E, Gnassingbé K, Chobli M. Anesthesia for children in Sub-Saharan Africa--a description of settings, common presenting conditions, techniques and outcomes. Paediatr Anaesth 2009; 19:5-11. [PMID: 19076495 DOI: 10.1111/j.1460-9592.2008.02838.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Ouro-Bang'na Maman AF, Agbétra N, Egbohou P, Sama H, Chobli M. [Perioperative morbidity and mortality in a developing country: experience of Lomé teaching hospital]. ACTA ACUST UNITED AC 2008; 27:1030-3. [PMID: 19010638 DOI: 10.1016/j.annfar.2008.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- A F Ouro-Bang'na Maman
- Service d'anesthésie-réanimation, CHU de Lomé (Togo), 05 BP 383 Agbalépédogan, Lomé, Togo.
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Jochberger S, Ismailova F, Lederer W, Mayr VD, Luckner G, Wenzel V, Ulmer H, Hasibeder WR, Dünser MW. Anesthesia and Its Allied Disciplines in the Developing World: A Nationwide Survey of the Republic of Zambia. Anesth Analg 2008; 106:942-8, table of contents. [DOI: 10.1213/ane.0b013e318166ecb8] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dünser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med 2006; 34:1234-42. [PMID: 16484925 DOI: 10.1097/01.ccm.0000208360.70835.87] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To give critical care clinicians in Western nations a general overview of intensive care medicine in less developed countries and to stimulate institutional or personal initiatives to improve critical care services in the least developed countries. DATA SOURCE In-depth PubMed search and personal experience of the authors. DATA SYNTHESIS In view of the eminent burden of disease, prevalence of critically ill patients in the least developed countries is disproportionately high. Despite fundamental logistic (water, electricity, oxygen supply, medical technical equipment, drugs) and financial limitations, intensive care medicine has become a discipline of its own in most nations. Today, many district and regional hospitals have units where severely ill patients are separately cared for, although major intensive care units are only found in large hospitals of urban or metropolitan areas. High workload, low wages, and a high risk of occupational infections with either the human immunodeficiency virus or a hepatitis virus explain burnout syndromes and low motivation in some health care workers. The four most common admission criteria to intensive care units in least developed countries are postsurgical treatment, infectious diseases, trauma, and peripartum maternal or neonatal complications. Logistic and financial limitations, as well as insufficiencies of supporting disciplines (e.g., laboratories, radiology, surgery), poor general health status of patients, and in many cases delayed presentation of severely sick patients to the intensive care unit, contribute to comparably high mortality rates. CONCLUSION More studies on the current state of intensive care medicine in least developed countries are needed to provide reasonable aid to improve care of the most severely ill patients in the poorest countries of the world.
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Affiliation(s)
- Martin W Dünser
- Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
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Dünser M, Baelani I, Ganbold L. [The specialty of anesthesia outside Western medicine with special consideration of personal experience in the Democratic Republic of the Congo and Mongolia]. Anaesthesist 2006; 55:118-32. [PMID: 16425039 PMCID: PMC7096088 DOI: 10.1007/s00101-006-0979-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the last decades anesthesia has developed into a wide ranging specialty in western countries, whereas in most developing and newly industrializing nations it still focuses on its core discipline, the perioperative care of the surgical patient. Poor socioeconomic status and inadequate financing of health systems result in a high burden of disease, a high rate of self-financing of healthcare costs by the patients, as well as insufficient personnel, infra-structural and material equipment of most healthcare facilities. Important limiting factors for anesthesia are low educational standards and a widespread lack of oxygen and medical gas supplies, as well as locally serviceable medical equipment. Studies evaluating the status of anesthesia in developing and newly industrializing nations in detail are urgently needed in order to provide aid on national and international as well as institutional and private levels for the development of anesthesia in poor countries.
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Affiliation(s)
- M Dünser
- Klinik für Anästhesie, Medizinische Universität, Innsbruck, Osterreich.
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Belkrezia R, Kabbaj S, Ismaïli H, Maazouzi W. [Survey of anesthesia practice in Morocco]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:20-6. [PMID: 11878117 DOI: 10.1016/s0750-7658(01)00555-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate qualitatively and quantitatively the anaesthetic activity in Morocco to identify of the priorities and the norm to recommend. STUDY DESIGN The investigation was realised from July 1999 to December 1999. It lasted seven days from Tuesday 8 PM to the following Tuesday 8 PM. A questionnaire was addressed to each hospital. One responsible has been chosen for each city. Data has been processed using the programming languages Microsoft Visual Basic. SETTING All Moroccan's hospitals practicing anaesthesia: university hospitals (UH), public hospitals (PH), and private sector (PS). PATIENTS All anaesthetic procedures realised by an anaesthetists; anaesthesia in medical office or dental surgery was excluded. RESULTS An inventory of 2,630 anaesthesia was made. Anaesthesia distribution according to the type of hospitals was the same; PH = 35.7%, UH = 34.3% and PS = 29.96%. The preanaesthetic consultation was achieved in 47% of cases. Premedication was done in 28.5% of cases. General anaesthesia represented 3/4 of total anaesthesia. Thiopental was the drug the more frequently used. Gallamine and pethidine were still used in PH. Locoregional anaesthesia was realised in only 15% of cases. Electrocardioscopic surveillance not constant (65%), capnography almost absent in PH, pulse oximetry used in UH and PS. Ambulatory anaesthesia was used in 20% and emergency surgery in 30% of cases. CONCLUSION Questioning about the Moroccan practice of anaesthesia is raised by this survey mostly because of drugs and monitoring use.
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Affiliation(s)
- R Belkrezia
- Service d'anesthésie-réanimation, hôpital des spécialités, Rabat, Maroc
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Carpentier JP, Banos JP, Brau R, Malgras G, Boye P, Dubicq J, Angel G, Roth C. [Practice and complications of spinal anesthesia in African tropical countries]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:16-22. [PMID: 11234572 DOI: 10.1016/s0750-7658(00)00329-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the risk of the practice of spinal anaesthesia (SA) in African tropics. STUDY DESIGN Prospective study in multiple centres over a two years period. PERSONS Twenty-one anaesthesiologists and anaesthetist nurses covering ten African countries. METHODS Two anonymous questionnaires; the first, filled in each anaesthetic problem occurred, to define the type of incident or accident, and its circumstances; the second was designed to define the position occupied, to quantify the global anaesthetic activity, the number of SA, and to value the number of complications or deaths linked to SA. RESULTS Six anaesthesiologists and one anaesthetist nurse replied to the study, covering six sites in five different countries (Senegal, Chad, Central African Republic, Niger and Madagascar). On the 18,432 anaesthetic acts collected, 2,703 (14.7%) were SA. In the well-equipped centres, general anaesthesia was predominant with a frequency of over 75%. However in the not so well equipped centres or those which supplies were more problematical, SA technique was used with a frequency varying from 48.9 to 68.7%. Forty incidents and accidents were reported (1.5%), five led to the death of the patient (0.2%). Among the seven cardiac arrests (0.3%), four were fatal (0.1%). Eight of the ten accidents and all of the deaths occurred in the least equipped centres. Eight of ten accidents happened during emergency caesarean sections. All cardiac arrests were preceded by a severe hypovolemia. For the four deaths after cardiac arrest, an anaesthetist nurse with isobaric bupivacaine 0.5% carried out SA. CONCLUSIONS This study showed that the practice of SA in African tropics was performing in different practice conditions and people qualification than they were in France. The frequency of cardiac arrests and deaths was respectively five and 20 times more important, in those conditions. The first conclusion that can be drawn from this study is that it is questionable to use SA for emergency Caesarean section under hypovolemic condition. The second is the necessity for specific training on the local anaesthesia for anaesthetist nurses but also training to choose the anaesthesia best adapted to the surgery, the condition of the patient and the means available.
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Affiliation(s)
- J P Carpentier
- Département d'anesthésie-réanimation-urgences, HIA Laveran, Marseille, France
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Chobli M. [Reducing anesthetic morbidity and mortality in developing countries: a priority in obstetrics and pediatric surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:619-20. [PMID: 10464526 DOI: 10.1016/s0750-7658(99)80145-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adnet P. [Promoting education in anesthesia and intensive care in developing countries]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1999; 18:621-2. [PMID: 10464527 DOI: 10.1016/s0750-7658(99)80146-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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