Anesthetic Management of Hepatic Resection in a Low-Resource Setting: First Bulletin from Africa

Introduction: General anesthesia and antisepsis have made intraperitoneal surgery safer. With the improvement of anesthetic techniques and the development of new surgical approaches, the liver, an organ with high haemorrhagic risks, has become the subject of many successful therapeutic indications. Although widely performed in high-income settings due to a better technical platform, the reverse is true for low-resource settings in Africa where there is little or no report on the anesthetic management of this dreadful surgery. Hence, this study is one of the first from Africa to report on the perioperative anesthetic management and outcome of hepatic resections. Methods: This was a retrospective case series study conducted over four years (2019-2022) through a chart review of all medical and anesthesia records of patients admitted to Douala General Hospital, Cameroon for hepatic resection. We collected socio-demographic, clinical, laboratory and intraoperative data, the estimated financial cost and patient outcomes. Results: Twelve open hepatic resections were performed mainly electively (11/12 cases) for localized hepatic tumours (7/12 cases) on ASA II patients (11/12 cases) with a mean age of 36.5 years and sex ratio of 1.2. Pre-anesthetic consultations were usually done within 24 days before the surgery. General anesthesia maintained with sevoflurane was the mainstay anesthetic technic. Continuous hemodynamic monitoring with an arterial catheter was done. The blood-sparing strategy was based on tranexamic acid, calcium gluconate and controlled hypotension with an intraoperative transfusion rate of 33.33%. The cost of the procedures was well above the minimum wage in Cameroon but relatively cheap compared to the cost in high-income countries. No perioperative death was recorded. Conclusion: Our hepatic resections were managed with satisfactory blood savings, low morbidity and zero perioperative mortality. Overall, this study is the first to provide data on perioperative anesthetic management and outcomes of hepatic resection in Africa.

Experience of Analgesia during Labour in a Sub-Saharan Hospital Setting

The pain experienced during labour varies from one person to another. The objective of this study is to evaluate the experience of analgesia during labour in three maternity hospitals in Cameroon. Methodology: This was a cross-sectional analytical study conducted over 4 months, from 1 December 2019 to 31 March 2020, at the Yaoundé Gynaecological-Obstetric Hospital, the Yaoundé Central Hospital and the Douala General Hospital. We compared 35 parturients who delivered vaginally under analgesia and 79 parturients who delivered without analgesia. The data collected were compared using Chi 2 and Fischer tests with a significance level of P Results: Parturients aged 30 - 40 years (P = 0.03), public sector employees (P = 0.002) and private sector employees (P Conclusion: Analgesia delivery offers a better birth experience, however it may have negligible side effects.

Anesthetic Management of a Rare Penetrating Traumatic Brain Injury Caused by a Pickaxe: A Case Report

Penetrating traumatic brain injuries (TBI) are frequent neurosurgical emergencies, associated with a high mortality rate and we almost no previous report on a penetrating pickaxe TBI. Herein, we report and discuss the anesthetic challenges encountered in the surgical extraction a pickaxe from a patient with TBI. We present the case of a 34-year-old man who with a penetrating pickaxe TBI at his left temporal region, signs of raised intracranial pressure and normal vital signs. Anesthetic management began within 3 hours of admission and consisted of general anesthesia and rapid sequence intubation. Surgical extraction of a 14 cm long wing of the pickaxe was achieved with good hemostatic control. His postoperative course was marked by complete blindness of the right eye till one year of follow-up. The authors highlight the need of a prompt multidisciplinary management with close perioperative monitoring of haemostatic control and signs of raised intracranial pressure as key factors for a favourable postoperative outcome.