[Prevention of the acute tolerence with fentanyl by ketamine]. / Prévention de la tolérence aigue au fentanyl par la kétamine à faible poids.

INTRODUCTION: The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine. MATERIALS AND METHODS: We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery. RESULTS: Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1. CONCLUSION: The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.

[Intensive care management of HELLP syndrome in Dakar]. / Prise en charge du HELLP syndrome en réanimation à Dakar.

OBJECTIVE: To evaluate the intensive management of HELLP syndrome in a intensive care unit in African setting. STUDY DESIGN: Descriptive and analytical retrospective study. PATIENTS AND METHODS: All patients hospitalized between June 1998 and June 2004 for HELLP syndrome were included in the study. Following parameters were studied: age, parity and gestity, term of pregnancy, delay before admission in ICU, data clinical, biological parameters, medical treatment, obstetrical treatment, maternal complications, maternal and foetal prognosis. RESULTS: Twenty patients of average age 26.3 years with seven primigeste and 13 pauci and miltigeste were admitted in ICU during the period of study for HELLP syndrome. The average time of admission was 1.35 days; 13 patients had HELLP syndrome in ante partum and seven patients in postpartum. Serious complications were noted at admission in the majority of patients with oligoanuric renal insufficiency in 11 cases, eclampsia in eight cases and intravascular coagulation disseminated in four cases. The mode of delivery in patients for HELLP syndrome occurring in ante partum was the Caesarean section under general anaesthesia in five cases and vaginal delivery in eight cases. All the patients for HELLP syndrome in the postpartum had been confined by low way. The maternal evolution was favourable in 13 cases. Seven patients of which five with HELLP syndrome who occurred in ante partum had died. The infant mortality was noted in eight cases primarily in cases of HELLP syndrome which occurred in ante partum.

[Diabetic ketoacidosis of the child revealed by a pseudo-surgical acute abdomen. A case report]. / Acidocétose diabétique de l'enfant révélée par un tableau d'abdomen aigu pseudo-chirurgical: a propos d'un cas.

Ketoacidosis is a frequent mode of revelation of diabetes of the child. Signs of diabetes are generally unperceived or are badly interpreted by the family entourage. We report a case of diabetic ketoacidosis in an eight-year-old child without particular medical history. The context of discovery was an acute abdomen by gastric dilatation in a severe context of dehydration. Evolution was quickly favourable after medical treatment with disappearance of acute abdominal signs (clinical and radiological). This observation enables us to recall, by the light of a review of the literature, that diabetic ketoacidosis can be revealed by pseudo-surgical acute abdomen and treatment is purely medical.

[Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study]. / Anesthésie-Reanimation dans la chirurgie des complications pleuropulmonaires de la tuberculose: a propos de 79 cas.

Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

[Anesthesia in the surgery of hyperthyroidism at Le Dantec Teaching Hospital]. / Anesthésie dans la chirurgie de l'hyperthyroïdie au CHU Le Dantec.

Authors report a study of 66 patients admitted to the clinic ORL of CHU Le Dantec between 1991 and 2000 for goiter and hyperthyroidism. They evaluate the perioperative management and underline the importance of the medical preparation. The age of patients varied between 15 and 74 years. There were 62 women and 4 men. Fifty three patients presented clinical and biological hyperthyroidism. Thirteen patients had functional hyperthyroidism without clinical signs of thyrotoxicosis. Exophthalmia was present in 20 patients. Twenty one patients have been addressed to the Internal Medicine service for preoperative management of hyperthyroidism. Forty five patients have been operated under general anaesthesia. The medical preparation comprised antithyroid drugs and beta-blockers. We found as complications 3 cases of difficult intubation, 7 cases of peroperative haemorrhage and 1 case of acute thyroid crisis. The anaesthesia for surgery of hyperthyroidism is currently well codified and operative outcome became simple. The medical preparation in case of hyperthyroidism allows to return the patient in euthyroidism and reduces considerably the acute thyroid crisis risk, the most fearsome complication and the most feared of the hyperthyroidism.