Incidence of Post-Operative Complications and Factors Influencing Their Occurrence in Patients with Sickle Cell Disease in a Low-Income Country: A Case Study of Cameroon.

This study aimed to analyse post-operative complications and possible factors influencing their occurrence in the management of patients with sickle cell disease in a low-income country. We prospectively collected data regarding the management of patients with sickle cell disease requiring anesthesia for surgery in 11 Cameroonian hospitals from 1 May 2019 to 30 April 2021. The data were analysed using descriptive statistics and a binary logistic regression was used to determine the dependence between the variables. A total of 124 patients with sickle cell disease were enrolled; 64 were male and 60 female, giving a sex ratio of 0.93. The rate of post-operative complications was 23.4% (29/124) and the death rate was 3.2% (4/124). The female subjects had more complications than the male subjects p < 0.05. The number of vaso-occlusive crises experienced per year showed a significant impact on the occurrence of post-operative complications p < 0.05. Laparoscopic surgery had fewer post-operative complications 5/46 (10.9%) than laparotomy 14/43 (32.5%). The surgical technique for the abdominal procedures had a significant impact on the occurrence of post-operative complications p < 0.05. The type of surgery (p = 0.198) and the anaesthesia technique (p = 0.225) did not show a significant impact on the occurrence of post-operative complications. Particular attention should be paid to female patients with sickle cell disease as they are more likely to experience post-operative complications, as well as to the frequency of vaso-occlusive crises, which are also predictive of post-operative complications. Opting for laparoscopic surgery whenever possible would help to reduce post-operative complications.

Pharmacodynamics of rocuronium in sickle cell patients.

BACKGROUND: Sickle cell disease is the most widespread genetic disease in the world. The chronic organ damage due to this disease could lead to variability of responses to the anaesthetic drugs. We analysed the pharmacodynamics response of rocuronium to sickle cell patients. METHODS: We observed and compared the onset time and clinical duration (time to recovery first twitch) of 0.6 mg kg-1 of rocuronium using a TOFscan® monitor, as well as the time before the first incremental dose (time to recovery second twitch), in a group of 22 homozygous sickle cell patients and a group of 23 controls, all programmed for laparoscopic surgical procedures. RESULTS: The onset time of rocuronium was longer in sickle cell patients [mean ± SD (extremes)], [6.3 ± 2.1 (1.8-10) min] than in the control group [2.5 ± 0.6 (1.4-3.5) min] (P < 0.01). The clinical duration was shorter in sickle cell patients [19.2 ± 7.1 (13-41) min] when compared to the control group [28.9 ± 6.9 (21-48) min] (P < 0.01). The time before the first incremental dose was shorter in the sickle cell patients group [27.7 ± 7.9 (19-49) min] compared to the control group [39.9 ± 8.7 (30-56) min] (P < 0.01). CONCLUSION: The onset time of rocuronium was significantly longer with a shorter duration of action in patients with sickle cell disease versus the general population.

Cannabis body packing: a case report.

Drug traffic is a major concern worldwide. We report a case of a 27-year old male who presented with a diffuse abdominal plain to the emergency department. Abdominal X-ray demonstrated multiple foreign bodies along the intestinal tract, which were found to be cannabis packets. The patient was treated conservatively with a good result.

Totally laparoscopic esophago-gastrectomy.

The recent progress of surgical endoscopy has allowed to perform minimally invasive esophagectomy both by a combined laparoscopic/thoracoscopic and a totally laparoscopic transhiatal approach. Up to now, all these techniques imply a thoracic (or thoracoscopic) and/or cervical access to perform the esophagogastric anastomosis. In the presented case, a 44-year-old white male patient affected by adenocarcinoma of the cardia (Siewert type 2) underwent a distal esophagectomy entirely accomplished by laparoscopy (including the realization of a mechanical intrathoracic esophagogastrostomy), without the need of any thoracic (nor thoracoscopic) nor cervical access. Duration of surgery was 407 minutes. Postoperative course was uneventful and the patient was discharged on day 7. In selected cases, a totally laparoscopic esophago-gastrectomy without thoracic nor cervical access, may improve the patient's outcome