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Anesthesia Practice for Hip Fractures in the Elderly at University Hospital Aristide Le Dantec of Dakar, Republic of Senegal
Gilles Niengo Outsouta,
Papa Ibrahima Ndiaye,
Christ Mayick Mpoy Emy Monkessa,
Marie Elombila,
Peggy Dahlia Gallou Leyono-Mawandza,
Papa Alassane Leye,
Berlinda Erna Essenam Vanessa de Medeiros,
Gilbert Fabrice Otiobanda,
Elisabeth Diouf
Issue:
Volume 10, Issue 1, June 2022
Pages:
1-7
Received:
22 January 2022
Accepted:
11 February 2022
Published:
25 February 2022
DOI:
10.11648/j.ijacm.20221001.11
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Abstract: Aim: to describe the perioperative management of hip fractures in the elderly at Aristide Le Dantec University Hospital, in Dakar. Materials and Methods: It was a single-center retrospective study, over 24 months, in the surgical emergency rooms of the university hospital Aristide Le DANTEC in Dakar. We Included anyone person aged at least 65 years and over, who had undergone emergency hip surgery. The epidemiological, preoperative, intraoperative and immediate postoperative variables were analyzed on Excel 2019. Results: We collected 105 patients with a mean age of 75.2±7.7 years and 61.9% of women. The average of hospitalization delay was 3.7±5.6 days. Extracapsular hip fracture represented 58.1% of patients. 92.4% of the patients had an admission-surgery delay greater than 48 hours. 52.4% of patients had a comorbidity, dominated by high blood pressure (37.4%) and diabetes (14.7%). The MET-Score had not been assessed. The class 2 of ASA classification (69.5%) and the level 1 of Lee's score (73.3%) were the most represented. Complete blood count and ECG were performed for all patients. Blood hemostasis test and Transthoracic Echography were not justified for 98.9% and 32% of patients, respectively. Perimedullar anesthesia was performed in 92.4% of patients. Continuous spinal anesthesia for 35.6% of patients. A peripheral nerve block for analgesia was performed for 11.4% of patients. 15.2% of patients suffered of an Intraoperative hypotension. One patient suffered of a total spinal anesthesia. 4.8% of patients received an intraoperative blood transfusion. The surgery lasted an average of 116.1±35.2 minutes. Postoperative pain (POP) was treated with paracetamol (100% of patients) and tramadol (66.7% of patients). 99.1% of patients were admitted to the post-intervention care room. Conclusion: The perioperative management of hip fracture in the elderly at the University Hospital Aristide Le Dantec reveals an excessive and unjustified prescription of paraclinical examinations, which delays operating time.
Abstract: Aim: to describe the perioperative management of hip fractures in the elderly at Aristide Le Dantec University Hospital, in Dakar. Materials and Methods: It was a single-center retrospective study, over 24 months, in the surgical emergency rooms of the university hospital Aristide Le DANTEC in Dakar. We Included anyone person aged at least 65 years...
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Effect of Intravenous Tranexamic Acid as an Adjunct Haemostat with Pericervical Tourniquet on Perioperative Blood Loss Following Open Abdominal Myomectomy
Asudo Felicia Dele,
Okonkwo Azubuike Venatius,
Isamade Erdoo Suckie,
Abdullahi Ibrahim Habib
Issue:
Volume 10, Issue 1, June 2022
Pages:
8-15
Received:
4 February 2022
Accepted:
1 March 2022
Published:
18 March 2022
DOI:
10.11648/j.ijacm.20221001.12
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Abstract: Uterine fibroid is a common gynaecological tumour. Abdominal myomectomy is a common surgical treatment for these women. Open abdominal Myomectomy is associated with significant risk of hemorrhage and the need for perioperative homologous blood transfusion with its potential risks, complications and cost. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery. Its efficacy in reducing blood loss when used as an adjunct to pericervical tourniquet has not been elucidated. In a double blind, placebo-controlled trial, we assessed the effect of intravenous tranexamic acid as an adjunct haemostat with pericervical tourniquet on perioperative blood loss following open abdominal myomectomy in 132 ASA I-II women, aged 18–65 years, who had abdominal myomectomy. The patients were randomly allocated to receive either intravenous Tranexamic acid 1gm (n=66) or placebo (n=66) pre-operatively on arrival in theatre immediately after securing an IV access. All the patients also had a peri-cervical tourniquet applied intraoperatively to secure haemostasis. The volume of intraoperative blood loss, haemodynamic changes associated with blood loss and the complications associated with the use of tranexamic acid were evaluated during the first 72 hours following surgery. One hundred and thirty one (131) patients completed the study; Tranexamic acid group 66 and placebo group 65. One patient in the placebo group had uncontrollable postoperative haemorrhage. This necessitated her having total abdominal hysterectomy. She was thus disqualified from the study. Blood loss was significantly lower in the tranexamic acid group. Mean intraoperatively mean arterial pressure (MAP) compared to baseline was lower in the placebo while the mean intraoperative pulse rate compared to the baseline was higher in the placebo group. The only notable perioperative complication was nausea and vomiting. There was no difference in occurrence of complications between the groups. This study shows that intravenous tranexamic acid as an adjunct haemostat with pericervical tourniquet reduced blood loss, provide better haemodynamic stability with acceptable side effects during abdominal myomectomy.
Abstract: Uterine fibroid is a common gynaecological tumour. Abdominal myomectomy is a common surgical treatment for these women. Open abdominal Myomectomy is associated with significant risk of hemorrhage and the need for perioperative homologous blood transfusion with its potential risks, complications and cost. Tranexamic acid is a synthetic lysine deriva...
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A Comparative Study Between Tranexamic Acid (TXA) and Fibrinongen Concentrate in Bleeding Control of Total Hip Arthroplasty (THA)
Jehan Mohammad Ezzat Hamed,
Rabab Mohamed Mohamed
Issue:
Volume 10, Issue 1, June 2022
Pages:
16-23
Received:
23 March 2022
Accepted:
9 April 2022
Published:
14 April 2022
DOI:
10.11648/j.ijacm.20221001.13
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Abstract: Total hip arthroplasty (THA) faces the hazard of surgical blood loss and significant invisible blood loss due to bleeding into tissue and hemolysis. Tranexamic acid (TXA) and fibrinogen are important agents among a diversity of intraoperative blood management protocols. During the coagulation cascade, thrombin enhances fibrinogen and hastens fibrin polymerization forming an intense network important in clot formation. Our study included sixty male patients that were randomized into two groups; patients receiving 15 mg/kg TXA given as a single slow intravenous bolus injection 15 minutes before incision were placed in (group 1). Patients receiving 30 mg/kg fibrinogen concentrate administered post induction of general anesthesia were placed in (group 2). Intraoperative (IO) mean heart rate (HR) and mean arterial pressure (MAP) showed no significant differences. There was a significant decrease in IO blood loss in fibrinogen (723.03. ± 117.69) group compared to TXA (879.30 ± 168.54) (p=0.001), with significant (P=0.010) differences in the amount of transfused packed RBCs (IQR:1-2). Field visibility also improved significantly (p=0. 017) in fibrinogen group. The amounts of Lactated Ringer’s (LR) solution infused during surgery were not significantly different while a significant (p=0.037) decrease in the additional amount of hydroxyethyl starch (HES) solution infused in patients with fibrinogen (211.87 ± 32.30) over TXA (250.63 ± 43.65) was noted. In conclusion, administration of fibrinogen concentrate before procedure in patients undergoing THA reduces blood loss. Consequently, this therapeutic process has the potential to change the treatment model for perioperative hemorrhage in patients with potentially life-threatening coagulopathy.
Abstract: Total hip arthroplasty (THA) faces the hazard of surgical blood loss and significant invisible blood loss due to bleeding into tissue and hemolysis. Tranexamic acid (TXA) and fibrinogen are important agents among a diversity of intraoperative blood management protocols. During the coagulation cascade, thrombin enhances fibrinogen and hastens fibrin...
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Examining the Consent Process for Anesthesia in Emergency Caesarean Section
Chulei Ji,
Guanghao Zhang,
Ru Yu,
Ya Su,
Xianjie Zhang
Issue:
Volume 10, Issue 1, June 2022
Pages:
24-27
Received:
7 April 2022
Accepted:
20 April 2022
Published:
28 April 2022
DOI:
10.11648/j.ijacm.20221001.14
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Abstract: Cesarean section is a very effective protective measure for mother and fetus, as it could solve obstructed labor and some cases requiring timely delivery. Spinal or epidural anesthesia does not require intubation and could effectively reduce the risk of aspiration of gastric contents, which is considered to be the best anesthesia for cesarean section. However, in special situations such as fetal distress, general anesthesia is often adopted by anesthesiologists because of its quick and powerful effect. Adverse effects of general anesthesia include reflux, aspiration, postoperative nausea and vomiting, hypoxemia and insufficient ventilation, which are not good for the mother and the fetus. Before signing the consent form, the anesthesiologist should explain the advantages and risks of each type of anesthesia to the mother and her family. However, in the case of emergency cesarean section to buy time for the operation, anesthesiologists may adopt paternalistic style and tandemly explain the risks of anesthesia to the puerperal, thus ignoring the informed consent and decision-making rights of the puerperal and her family members. It is a challenge for anesthesiologists to ensure maternal autonomy while ensuring the safety of the mother and fetus. This paper discusses the thinking mode and key points of anesthesiologists and nurses in the course of anesthesiologists' and nurses' roles in order to avoid violating ethics in practice.
Abstract: Cesarean section is a very effective protective measure for mother and fetus, as it could solve obstructed labor and some cases requiring timely delivery. Spinal or epidural anesthesia does not require intubation and could effectively reduce the risk of aspiration of gastric contents, which is considered to be the best anesthesia for cesarean secti...
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Management of Post-Dural Puncture Headache in Obstetric Surgery
Issue:
Volume 10, Issue 1, June 2022
Pages:
28-31
Received:
18 April 2022
Accepted:
4 May 2022
Published:
12 May 2022
DOI:
10.11648/j.ijacm.20221001.15
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Abstract: Post-Dural Puncture Headache is a complication of dual puncture. Although the incidence of PDPH decreased significantly after attention was paid to it, the incidence of post-partum depression, postpartum chronic headache, and back pain increased, which seriously affected the breastfeeding rate and the choice of epidural analgesia during delivery. Therefore, relevant operators should continue to pay attention to the occurrence of PDPH. The diagnosis of PDPH has been updated and described in the International Headache Classification to identify PDPH promptly. In this paper, the diagnostic criteria, pathogenesis, risk factors, and treatment plan of PDPH were summarized. The treatment plan was described in detail from four approaches: drug therapy, acupuncture, nerve block, and lumen administration. The application of epidural blood patches in patients was described in detail, and the complications were reminded to help users prevent related adverse reactions in the process. Finally, the authors suggest that recumbent rest and active fluid replacement are ineffective in the treatment of PDPH. The use of epidural blood patches is a feasible strategy for severe headaches after a rupture of the dual. It is hoped that through the management of this case, the occurrence of PDPH can be effectively avoided so that its impact on patients is less and less.
Abstract: Post-Dural Puncture Headache is a complication of dual puncture. Although the incidence of PDPH decreased significantly after attention was paid to it, the incidence of post-partum depression, postpartum chronic headache, and back pain increased, which seriously affected the breastfeeding rate and the choice of epidural analgesia during delivery. T...
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Internal Validation of a Subjective Bayesian Model for the Prediction of Anesthetic Accidents in Hospitals in Kinshasa
Berthe Nsimire Barhayiga,
Gibency Mpenda Mfulani,
Konde,
Rostin Matendo Mabela,
Adolphe Manzanza Kilembe,
Sylvain Mukongo Munyanga,
Christian Kisoka Lusunsi,
Benjamin Longo-Mbenza
Issue:
Volume 10, Issue 1, June 2022
Pages:
32-37
Received:
8 April 2022
Accepted:
2 May 2022
Published:
24 May 2022
DOI:
10.11648/j.ijacm.20221001.16
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Abstract: Background and Aims: This study evaluates the Subjective Bayes Model (SBM) by comparing it to the consensus of the 75 hypothetical cases having experienced an anesthetic accident, generated by the Experts. Methods: The experts generate the cases with anaesthetic accidents and determine the degrees of agreement within and between experts, the discrimination criterion called Cut Off Point (C.O.P.), and look for the values of the following parameters: sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), overall effectiveness value (VEG). Results: The laboration of the 75 hypothetical cases of anaesthetic accidents by the experts. The intra and inter expert agreement was 100% perfect reflecting the consistency of the experts. The MSB predicts the occurrence of AA in 37 cases and the non-occurrence of AA in 27 cases confirmed by the consensus of the experts: the discrimination criterion (Cut of point = COP) is equal to 0.5, the MSB presents a good intrinsic validity with test performances of Se = 94. 8%, Sp = 75%, VP = 80%, NPV = 93% and VEG = 85%, the MSB gave an 80% probability that an AA identified as having occurred would actually occur (PPV) and a 93% probability that an AA identified as not having occurred would not occur (NPV). Conclusion: Expert consensus on the occurrence of SAs in the 75 hypothetical cases of anaesthetic accidents generated by the Experts was used to determine the internal validation of the Subjective Bayes Model of anaesthetic accident prediction.
Abstract: Background and Aims: This study evaluates the Subjective Bayes Model (SBM) by comparing it to the consensus of the 75 hypothetical cases having experienced an anesthetic accident, generated by the Experts. Methods: The experts generate the cases with anaesthetic accidents and determine the degrees of agreement within and between experts, the discri...
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Peri-Operative Management of a Von Recklinghausen's Disease Royal Tumor: About a Case
Mbaye Diaw,
Papa Alassane Leye,
Alioune Badara Thiam,
Abdou Kane Diop,
El Hadj Ndiasse Diop,
Ndeye Aissatou Bagayogo,
Sagar Diop,
Mouhamadou Moustapha Ndongo,
Papa Ibrahima Ndiaye,
Elisabeth Diouf
Issue:
Volume 10, Issue 1, June 2022
Pages:
38-43
Received:
16 May 2022
Accepted:
14 June 2022
Published:
27 June 2022
DOI:
10.11648/j.ijacm.20221001.17
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Abstract: The royal tumor is a very hemorrhagic tumor reflecting the preponderant and monstrous development of a plexiform neurofibroma or a deep tumor of a nerve trunk. We report the case of a 29-year-old patient with a large and painful tumor attached to the lumbosacral region by an implantation base 40cm wide, avoiding dorsal decubitus and associated with symptoms of slow dorsal spinal cord compression and diffuse cutaneous neurofibromas localized on the face, neck and thorax. MRI showed a large soft tissue tumor with intraspinal invasion in D8. Histology of the tumor confirmed the diagnosis of neurofibromatosis at the stage of cancerization with a profile in favor of a leiomyosarcoma with a myxoid aspect. We present through this case the possibility of the preponderant and monstrous development of a neurofibroma of Von Recklinghausen, his cancerization and the challenge of the anesthetic management.
Abstract: The royal tumor is a very hemorrhagic tumor reflecting the preponderant and monstrous development of a plexiform neurofibroma or a deep tumor of a nerve trunk. We report the case of a 29-year-old patient with a large and painful tumor attached to the lumbosacral region by an implantation base 40cm wide, avoiding dorsal decubitus and associated with...
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