Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anest...Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4<sup>th</sup> post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.展开更多
Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. ...Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. Method: It was a retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion and intraoperative data. The primary outcome was intraoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 97 patients included, the average age was 74.2 years ± 10, male predominance was 73.2%, the average ASA score was 1.9 ± 0.5, and transfusion incidence was 38.1%. The average number of RBCs transfused was 1.2 ± 0.6. Tranexamic acid was used in 11.3% of patients. The average bleeding was 450 ± 453 ml. Preoperative anemia was predictor of transfusion to be significant. Conclusion: The incidence of transfusion is law compared to total hip arthroplasty. The implementation of a patient blood management protocol is difficult given the urgency of bone repair. However, a better use of tranexamic acid could reduce this transfusion incidence.展开更多
Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique th...Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO<sub>2</sub>/FiO<sub>2</sub> ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.展开更多
Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to gu...Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.展开更多
Context: Subparaneural injection (under the nerve sheath) has reduced the onset of action and the effectiveness of local anesthetics in sciatic blocks. The objective of this work was to assess the effectiveness of thi...Context: Subparaneural injection (under the nerve sheath) has reduced the onset of action and the effectiveness of local anesthetics in sciatic blocks. The objective of this work was to assess the effectiveness of this technique in axillary blocks in two hospitals in France and Gabon. Method: From January 1 to February 28, 2019, patients were included for upper limb surgery under xylocaine or Ropivacaine. The installation time, effectiveness, occurrence of paresthesia, and vascular breaches were assessed. Results: 141 patients were included, mostly male (64.55%), with an ASA 1 score (46.1%), hand surgery predominated (95%) most often performed as scheduled surgery (68.1%). Block was performed by the anesthesiologist in 39% of patients and by the anesthesiologist student in 61% of patients. The success rate was 88.66% with an installation time of 15 min, some paresthesias were noted. Despite the lack of expertise from a Gabonese hospital center, the data were compared to the literature. Conclusion: Ultrasound-guided subparaneural injection axillary block is an effective, safe technique with a rapid learning curve.展开更多
文摘Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4<sup>th</sup> post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.
文摘Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. Method: It was a retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion and intraoperative data. The primary outcome was intraoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 97 patients included, the average age was 74.2 years ± 10, male predominance was 73.2%, the average ASA score was 1.9 ± 0.5, and transfusion incidence was 38.1%. The average number of RBCs transfused was 1.2 ± 0.6. Tranexamic acid was used in 11.3% of patients. The average bleeding was 450 ± 453 ml. Preoperative anemia was predictor of transfusion to be significant. Conclusion: The incidence of transfusion is law compared to total hip arthroplasty. The implementation of a patient blood management protocol is difficult given the urgency of bone repair. However, a better use of tranexamic acid could reduce this transfusion incidence.
文摘Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO<sub>2</sub>/FiO<sub>2</sub> ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.
文摘Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.
文摘Context: Subparaneural injection (under the nerve sheath) has reduced the onset of action and the effectiveness of local anesthetics in sciatic blocks. The objective of this work was to assess the effectiveness of this technique in axillary blocks in two hospitals in France and Gabon. Method: From January 1 to February 28, 2019, patients were included for upper limb surgery under xylocaine or Ropivacaine. The installation time, effectiveness, occurrence of paresthesia, and vascular breaches were assessed. Results: 141 patients were included, mostly male (64.55%), with an ASA 1 score (46.1%), hand surgery predominated (95%) most often performed as scheduled surgery (68.1%). Block was performed by the anesthesiologist in 39% of patients and by the anesthesiologist student in 61% of patients. The success rate was 88.66% with an installation time of 15 min, some paresthesias were noted. Despite the lack of expertise from a Gabonese hospital center, the data were compared to the literature. Conclusion: Ultrasound-guided subparaneural injection axillary block is an effective, safe technique with a rapid learning curve.
