Introduction: The practice of spinal anesthesia in pediatric surgery is declining, especially in countries with limited means. What about in our context? Objective: To evaluate the practice of spinal anesthesia in pediatric surgery in Togo. Framework and method of study: This was a prospective study from November 2017 to May 2018 in pediatric surgery at CHU SO de Lomé, in the operating room and hospital ward of CHU Kara. The surgical, anesthesiological and evolutionary aspects of the patients were analyzed. Results: Sixty children were selected for the study who had an indication for sub-umbilical surgery. The male sex was predominant (73.3%). 47 (78.30%) patients were operated on for scheduled surgery. Hernia repair was the most performed surgical intervention (43.30%). The mean duration of the surgery was 78 ± 35.9 minutes. Most of the patients were ASA 1 (98.30%). The local anesthetic used was 0.5% isobaric Bupivacaine. Fentanyl was the predominant adjuvant (55%). The most widely used lumbar puncture needle was 25 Gauge with 75 millimeters in length (63.30%). Diazepam was the most widely used sedative (50%). The predominant spinal anesthesia protocol was spinal anesthesia alone (60%). Only one patient had hypotension (1.70%). Conclusion: The fairly satisfactory pediatric spinal anesthesia in Togo remains poorly performed. Its promotion involves the training of anesthesia practitioners and the strengthening of the technical platform.
References
[1]
Lejus, C. and Magne, C. (2015) Spinal Anesthesia in Children: Should It Still Be Used? Le Praticien en Anesthésie Réanimation, 19, 120-124. https://doi.org/10.1016/j.pratan.2015.04.004
[2]
Abajian, J.C., Mellish, R.P., Browne, A.F., et al. (1984) Spinal Anesthesia for Surgery in the High-Risk Infant. Anesthesia & Analgesia, 63, 359-362. https://doi.org/10.1213/00000539-198403000-00015
[3]
Ecoffey, C., Lacroix, F., Giaufre, E., et al. (2010) Epidemiology and Morbidity of Regional Anesthesia in Children. A Follow-Up 1-Year Prospective Survey of the French-Language Society of Pediatric Anesthesiologists (ADARPEF). Paediatric Anaesthesia, 20, 1061-1069. https://doi.org/10.1111/j.1460-9592.2010.03448.x
[4]
Courrèges, P., Dadure, C., Ecoffey, C., et al. (2010) Locoregional Anaesthesia in Pediatrics. Formalized Recommendations of Experts.
[5]
Afane Ela, A., Ngayap, G., Owono Etoundi, P., et al. (2013) Spinal Anaesthesia in Children: Assessment of One Year’s Experience at the Yaoundé Central Hospital. Health Sciences and Diseases, 14, 1-5.
[6]
Zoumenou, E., et al. (2015) Practice of Anaesthesia in Children in Sub-Saharan Francophone Africa. State of Play and Perspectives for Improvement. Anesthésie & Réanimation, 1, 512-516. https://doi.org/10.1016/j.anrea.2015.10.008
[7]
Otiobanda, G.F., Mahoungou-Guimbik, K.C., et al. (2011) Practice of Paediatric Anaesthesia at the Brazzaville Hospital and University Centre. RAMUR, 16, 3-6.
[8]
Ogondon, B., Cesar, P.Y.D., et al. (2014) Practice of Pediatric Anesthesia in Emergency at Cocody Teaching Hospital. RCI, Abidjan.
[9]
Essola, L., Sima Zué, A., Obame, R., et al. (2013) Paediatric Anaesthesia in an African Setting: Experience of a Gabonese Hospital with an Adult Vocation. African Journal of Anesthesiology and Emergency Medicine (RAMUR), 18, 20-25.
[10]
Aissaoui, Y., Chkoura, K., Belhachmi, A., et al. (2013) Experience during Pediatric Surgical Missions. Annales Françaises d’Anesthésie et de Réanimation, 32, 447-452. https://doi.org/10.1016/j.annfar.2013.07.079
[11]
Molliex, S., Pierre, S., Bléry, C., et al. (2012) Systematic Preoperative Examinations. Formalised Expert Recommandations. Annales Françaises d’Anesthésie et de Réanimation, 31, 752-763. http://www.cfar.org/index.php/epp/programmes-epp.html https://doi.org/10.1016/j.annfar.2012.06.009
[12]
El Hammoumi, J. (2015) Pratique de l’anesthésie locorégionale au service d’anesthésie réanimation mère-enfant CHU HASSANE II FES-Etude prospective. Mémoire de Diplôme Médical de Spécialité option anesthésie réanimation, Juin, Fès (MAROC), 26-28.
[13]
Jon, L.J., Craven, P.P., Lakkundi, A., et al. (2015) Regional (Spinal, Epidural, Caudal versus General Anaesthesia in Preterm Infants Undergoing Inguinal Herniorraphy in Early Infancy. The Cochrane Database of Systematic Reviews, No. 6, CD003669.
[14]
Wolf, A.R. (2012) Effects of Regional Analgesia on Stress Responses to Pediatric Surgery: Stress Responses and Regional Analgesia. Pediatric Anesthesia, 22, 19-24. https://doi.org/10.1111/j.1460-9592.2011.03714.x
[15]
Imbelloni, L.E., Vieira, E.M., Sperni, F., et al. (2006) Spinal Anesthesia in Children with Isobaric Local Anesthetics: Report on 307 Patients under 13 Years of Age. Pediatric Anesthesia, 16, 43-48. https://doi.org/10.1111/j.1460-9592.2005.01680.x
[16]
Kokki, H. (2012) Spinal Blocks. Pediatric Anesthesia, 22, 56-64. https://doi.org/10.1111/j.1460-9592.2011.03693.x
[17]
Hmamouchi, B., Nejmi, S., Ifkharen, B., et al. (2006) Epidemiology of the Practice of Locoregional Analgesia in a Paediatric Anesthesiology Department. Annales Française d’Anesthésie et de Réanimation, 25, 1168-1170. https://doi.org/10.1016/j.annfar.2006.08.002
[18]
Kabaachi, O., Ben Rajeb, A., Mebazaa, M., et al. (2002) Spinal Anaesthesia in Children: Comparative Study of Hyperbaric Bupivacaine with or without Clonidine. Annales Françaises d’Anesthésie et de Réanimation, 21, 617-621. https://doi.org/10.1016/S0750-7658(02)00704-9
[19]
Rochette, A., Raux, O., Troncin, R., et al. (2004) Clonidine Prolongs Spinal Anesthesia in Newborns: A Prospective Dose Ranging Study. Anesthesia & Analgesia, 98, 56-59. https://doi.org/10.1213/01.ANE.0000093229.17729.6C
[20]
Kokki, H. and Hendolin, H. (2000) Hyperbaric Bupivacaine for Spinal Anesthesia in 7-18 Year Old Children: Comparison of Bupivacaine 5 mg/ml in 0, 9% and 8% Glucose Solutions. British Journal of Anaesthesia, 84, 59-62. https://doi.org/10.1093/oxfordjournals.bja.a013382
[21]
Aidan, K., Beloeil, H., Benhamou, D., et al. (2010) Rachianesthesia. Edition MAPAR, Bicêtre, 637.
[22]
Eledjam, J.J., Viel, E. and Bruelle, P. (1991) Headache after Spinal Anaesthesia in Children. In: Société Française d’Anesthésie Réanimation, Conférence d’actualisation, Masson, Paris, 193-208.
[23]
Gorce, P. (2004) Spinal Anaesthesia in Children. EMC—Anesthesia and Intensive Care, 1, 89-101. https://doi.org/10.1016/j.emcar.2003.09.001
[24]
Cook, B. and Doyle, E. (1996) The Use of Additives to Local Anaesthetic Solutions for Caudal Epidural Blockade. Pediatric Anesthesia, 6, 353-359. https://doi.org/10.1046/j.1460-9592.1996.d01-3.x
[25]
Vivien, B., Adnet, F., Chéron, G., et al. (2011) Sedation and Analgesia in Emergency Care. Formalized Expert Recommendations 2010 (Update of the 1999 SFAR Expert Conference). Annales Françaises de Médecine d’Urgence, 1, 57-71. https://doi.org/10.1007/s13341-010-0019-9
[26]
Giaufre, E., Le Gal, M. and Trinquet, F. (1992) Clinical Study of EMLA Anaesthetic Cream in Paediatric Locoregional Anaesthesia. Annales Françaises d’Anesthésie et de Réanimation, 11, 384-387. https://doi.org/10.1016/S0750-7658(05)80381-8
[27]
Puncuh, F., Kokki, H., Lampugnani, E., et al. (2004) Use of Spinal Anaesthesia in Paediatric Patients: A Single Center Experience with 1132 Cases. Pediatric Anesthesia, 14, 564-567. https://doi.org/10.1111/j.1460-9592.2004.01240.x
