Anesthésie­Réanimation dans la cure complète des cardiopathies congénitales au Sénégal au CHNU de fann

Le but de ce travail etait d'evaluer la prise en charge peri operatoire des cardiopathies congenitales au service de chirurgie thoracique et cardiovasculaire de Fann. Dans cette etude retrospective; 19 patients ont ete colliges sur un an (juin 2006 a juin2007). La tetralogie de Fallot etait la cardiopathie congenitale la plus frequente suivie des communications inter ventriculaires. Le temps moyen de circulation extracorporelle etait de 114 minutes et celui du clampage aortique de 49;78 minutes. Les complications post operatoires etaient metaboliques (7 cas); hemorragiques (5 cas) et infectieuses (2 cas). La mortalite etait de 10;5. La cure chirurgicale permet le retablissement de la physiologie normale et garantit une guerison complete

[Preventive measures and the strife against nosocomial infection]. / Les mesures préventives et la lutte contre les infections nosocomiales.

The nosocomial Infections are associated to an increase of the morbidity, of the mortality and costs. Their frequency stay on raised in our service of cares. Then it is recommended and broadly admitted what each hospital must dispose of a unity of nosocomial infections prevention and to dispose a staff specially vested in those duties. Of the fact the nosocomial infections frequency in reanimation, an imported part of the activity of this specialized staff will have to run out in services of intensive cares. The principal nosocomial infections feature observed is being directly or indirectly associated to engineerings of acting as invasives deputy used to palliate a vital lapse. Of a general manner, all sharp grave affection, as anything severe traumatism (accidental or surgical) drag a capacities reduction of defense against the infection, component so important factors of nosocomial infections installations. Preventive measures pass by the engineerings respect of hands hygiene, the harbour of clean conformable dress, the measures respect of isolation (septic or preventive), the cares grading, the upkeep of the hardware and the bedroom, the respect of the circuit of the linen salts and lastly the sorting and the losses management of activity of cares. For that it must a policy of strife against nosocomial infections with the placing in place of operational unities of hygiene in all hospitals and the redynamisation of the committee of strife against nosocomial infections already existed in different public establishments of health.

[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.

[Nosocomial ventilator-associated pneumonia in a tropical intensive care unit]. / Pneumopathies nosocomialesacquises sous ventilation mécanique dans un service de réanimation en milieu tropical.

INTRODUCTION: Nosocomial ventilator-associated pneumonia (VAP) occupy an important place among nosocomial infections and are responsible for a very high mortality. The objective of this work was to study epidemiologic, diagnostic and therapeutic aspects of ventilator-associated pneumonia in a tropical Intensive Care Unit and to release an adapted strategy of antimicrobial treatment. PATIENTS AND METHODS: It is a prospective descriptive study carried out from January to December 2002 in the polyvalent intensive care unit, in collaboration with the laboratory of bacteriology-virology of the CHU Dantec of Dakar. We included all the patients admitted and who presented radiological pulmonary infiltrates appearing after 48 hours of mechanical ventilation, associated to at least 2 clinic or biologic criteria and to a positive tracheal aspirate with a cut off value of 10(4) CFU/ml. RESULTS: Thirty two cases of VAP have been diagnosed among 446 patients admitted in our ICU. The incidence was 7.16 per 100 admitted patients and 50 per 100 ventilated patients. The reasons for ICU admission were dominated by trauma (44%). Microorganisms responsible of VAP were essentially Gram negative bacilli (GNB), 68% with in head the Pseudomonas. Acinetobacter strains were practically resistant to all usually used antibiotics. The more used antibiotics were gentamicine, 3rd generation cephalosporins and fluoroquinolones. Antibiotic treatment was appropriate in only 13 cases in 26 patients at whom intrinsic antibacterial activities of antimicrobial agents were examined. The mortality rate was of 81%. CONCLUSION: The improvement of the prognosis of these VAP require preventive measures with protocols of care, a qualified staff, diagnostic means and active antibiotics on the responsible pathogens.

[Role of MRI in the diagnostic of Gayet Wernicke's encephalopathy (GWE) after gastrectomy and parenteral nutrition]. / Apport de l'IRM dans le diagnostic de l'encéphalopathie de Gayet Wernicke (EGW): à propos d'un cas après gastrectomie et nutrition parentérale.

GWE is rarely described after gastric surgery following parenteral nutrition. The case of a 33 years old female with no previous alcohol addiction, who presented severe neurological disorders after reoperation for postoperative peritonitis and total parenteral nutrition is reported. She was operated 8 days before for gastric leiomyoma and underwent partial gastrectomy. The management has consisted of a tracheal intubation and welfare ventilation. The brain CT scan was normal and the brain MRI made the diagnostic of Gayet Wernicke's encephalopathy with typical signs. An inner, bilateral and symetrical on both sides of the 3rd ventricle, thalamic hypersignal. After treatment in ICU including mechanical ventilatory support and thiamine infusion, she recovered with minor neurological sequelae concicting in amnesia and false recognition. The control of MRI after 5 weeks returned to normal. Mandatory of thiamine to parenteral nutrition is recommended.

The recovery of Senegalese African blacks from intravenous anesthesia with propofol and remifentanil is slower than that of Caucasians.

UNLABELLED: Differences in sensitivity to anesthetic drugs have already been described among races. This study was designed to comparatively investigate the anesthetic requirements of two different ethnic groups: Caucasians and African blacks. Forty-five Caucasians from Italy and 45 African blacks from Senegal, who underwent general IV anesthesia with propofol and remifentanil, were comparatively evaluated for anesthetic depth and time lapsed before recovery. We used an electroencephalographic-derived index of depth of anesthesia, the bispectral index (BIS), and evaluation of clinical variables to assess the depth of anesthesia and the recovery trend. Mean BIS values from Caucasians after propofol discontinuation returned to baseline (92-100) in approximately 8 min, whereas in African blacks BIS values remained <80 for some 30 min. Time to eye opening was 10.6 +/- 4.8 min in Caucasians versus 16.9 +/- 8.8 min in African blacks (P < 0.001). Time to respond to loud verbal commands was 14.8 +/- 9.1 min in African blacks versus 9.1 +/- 4.2 min in Caucasians (P < 0.01). During anesthetic induction, the mean arterial pressure decreased by 20% in Caucasians and by only 10% in African blacks. We conclude that the recovery from general anesthesia with propofol was slower in African blacks compared with Caucasian patients. IMPLICATIONS: This study demonstrates statistically significant differences between Caucasians and African blacks in the arousal time from IV anesthesia with propofol and remifentanil. The authors conclude that the recovery from general anesthesia was slower in African blacks compared with Caucasian patients.

[Evaluation of preoperative complementary examination ordering]. / Evaluation de la prescription des examens complémentaires préopératoires.

The ordering of tests is often done in a systematical way. In spite of the studies which have proved that these tests are not useful, and despite the advice of the SFAR (1992) the ordering remains excessive, and is a source of expenses for the population. In that study we have done an evaluation for the ordering of preoperative tests in our structure and we have tried to see if the advice of the SFAR were followed, if they were sufficient to modify the habits of ordering the tests.