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Noninvasive Respiratory Strategies in Patients with Acute Hypoxemic Respiratory Failure and COVID-19 in Gabon: A Prospective Observational Study

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Open Journal of Emergency Medicine 2024年第1期12卷 18-27页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Fernande Manga Stéphane Oliveira Jean Marcel Mandji-Lawson Romain Tchoua department of Emergency anesthesia resuscitation Omar Bongo Ondimba Army Training Hospital Libreville Gabon department of anesthesia and resuscitation Libreville University Hospital Center Libreville Gabon department of anesthesia and resuscitation Akanda Army Training Hospital Libreville Gabon

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO2/FiO2 ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanic

关键词： Respiratory Failure COVID 19-Intensive Care Units Military Hospital Gabon

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Dosage Formula in anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

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Pharmacology & Pharmacy 2024年第4期15卷 71-80页

作者： Serge Ibula Rivain Iteke Berthe Barhayiga Doddie Tsansya Roger Cishugi Jean Jacques Kalongo Sandra Sagboze Jean Paul Cikwanine Dieudonné Sengeyi ISTM/Bukavu anesthesia-resuscitation Section CIMAC Hospital Center in Goma Goma The Democratic Republic of the Congo department of anesthesia-resuscitation University of Lubumbashi Lubumbashi The Democratic Republic of the Congo department of anesthesia-resuscitation University of Kinshasa Kinshasa The Democratic Republic of the Congo department of Gyneco-Obstetrics University of Kinshasa Kinshasa The Democratic Republic of the Congo anesthesia-resuscitation department Panzi Hospital Bukavu The Democratic Republic of the Congo

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formul

关键词： Dosage anesthesia Intrauterine Aspiration DR Congo

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Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the anesthesia-resuscitation department CHU Ignace Deen

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Open Journal of Emergency Medicine 2023年第4期11卷 162-173页

作者： Abdoulaye Touré Amadou Yalla Camara Almamy Bangoura M’mah Lamine Camara Mohamed Soumah Saramba Nabe department of anesthesia-resuscitation University Hospital of Ignace Deen of Conakry Conakry Guinea department of Medical and Surgical Emergency Donka University Hospital Conakry Guinea department of anesthesia-resuscitation Donka University Hospital Conakry Guinea

Objective: To describe the epidemiological, clinical, paraclinical and prognostic aspects of cerebral malaria received in the anesthesia-resuscitation department. Methodology: This was a prospective descriptive type study carried out in the anesthesia-resuscitation department over a period of three (03) months (June 01 to August 31, 2022). All patients admitted for cerebral malaria were included. Sociodemographic, clinical and prognostic parameters were studied. Results: We collected 25 cases out of 105 admitted patients (23.8%). The average age was 27.6 ± 9.5 years with extremes of 11 and 50 years. The sex ratio was 0.7 (M/F). Students and housewives were in the majority, i.e. 52% and 24%. Neurological disorders were found on admission in all patients, dominated by impaired consciousness at 100% followed by convulsion (60%), prostration (44%), confusion (36%) associated with deep coma in (68%). Gross hemoglobinuria was present in (84%) of cases. On the blood count, anemia was present in (70%) of the patients followed by thrombocytopenia in more than half of the cases (60%) and transfusion was necessary in 19 cases. P Falciparum malaria was found in all patients (100%), the average parasite density was 60342.8 ± 30425.6 trophozoites/μl with extremes of 9000 to 100000 trophozoites/μl. All our patients were treated with intravenous injectable artesunate. Transfusion was performed in 76% of our patients. Eighty percent of the patients had benefited from dialysis. High oxygen therapy was performed in (92%) of cases. The average duration of hospitalization was 5.74 ± days with extremes of 1 to 17 days. Mortality was 48%. Conclusion: Cerebral malaria can take different clinical forms, the most important of which is cerebral involvement. Prompt initiation of appropriate resuscitation can reduce mortality.

关键词： Cerebral Malaria Mortality resuscitation

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Left Hemispherical Subdural Hematoma on the Same Side as the Motor Deficit (Kernohan)

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Open Journal of Modern Neurosurgery 2024年第3期14卷 212-217页

作者： Mohamed Cherif Ibrahima Berete Souare I. S. Junior Alpha Boubacar Bah Seylan Diawara Boubacar A. Dramé Aboubacar M. Camara Elisabeth Traore Mohamed L. Sylla Oumar Sow Luc K. Beavogui Ibrahima S. Souare department of Neurosurgery Sino Guinean Friendship Hospital Conakry Guinea department of Neurosurgery Donka Hospital Conakry Guinea department anesthesia-resuscitation Friendship Hospital Conakry Guinea

Chronic subdural hematoma represents 25% of traumatic subdural collections;common in elderly subjects with a clear male predominance. It occurs over the age of 50 in more than 90% of cases and 50% of patients have no history of head trauma even if the latter remains the main risk factor with others such as coagulopathy, anticoagulant treatment, chronic alcoholic poisoning. Its discovery is rarely fortuitous and has an important clinical polymorphism including an intracranial hypertension syndrome (complete or incomplete). We report a clinical case of a left hemispheric subacute subdural hematoma with post-traumatic falcorial involvement in a 70-year-old patient admitted with a picture of impaired consciousness and weakness of the left hemibody. The objective of this work is to draw the attention of neurosurgeons and neurologists to the paradoxical existence of the neurological deficit on the same side as the causal brain lesion.

关键词： Subdural Hematoma Kernohan

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Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients:A Propensity Score Matching Study

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Current Medical Science 2024年第2期44卷 441-449页

作者： Bei-bei WANG Li HU Xin-yue HU Dong HAN Jing WU department of Anesthesiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Institute of anesthesia and Critical Care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Key Laboratory of Anesthesiology and resuscitation(Huazhong University of Science and Technology) Ministry of EducationWuhan430022China

Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological ***:This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March *** were collected for each patient,including demographics,disease status,surgical data,and clinical *** bowel preparation,postoperative gastrointestinal function,and electrolyte levels were compared between the two groups using propensity score matching(PSM).Results:The incidence of hypokalemia(serum potassium levelanesthesia was approximately 43.75%.After PSM,oral laxative use(96.4%vs.82.4%,P=0.005),the number of general enemas(P=0.014),and the rate of≥2 general enemas(92.9%vs.77.8%,P=0.004)were identified as risk factors for hypokalemia,which was accompanied by decreased PaCO_(2) and *** were no significant differences in postoperative gastrointestinal outcomes,such as the time to first flatus or feces,the I-FEED score(a scoring system was created to evaluate impaired postoperative gastrointestinal function),or postoperative recovery outcomes,between the hypokalemia group and the normal serum potassium ***:Hypokalemia during postanesthesia recovery period occurred in 43.75%of gynecological patients,which resulted from preoperative mechanical bowel preparation;however,it did not directly affect clinical outcomes,including postoperative gastrointestinal function,postoperative complications,and length of hospital stay.

关键词： hypokalemia gynecological surgery postanesthesia recovery perioperative electrolyte disturbances postoperative recovery

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Activation of G-protein-coupled receptor 39 reduces neuropathic pain in a rat model

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Neural Regeneration Research 2024年第3期19卷 687-696页

作者： Longqing Zhang Xi Tan Fanhe Song Danyang Li Jiayi Wu Shaojie Gao Jia Sun Daiqiang Liu Yaqun Zhou Wei Mei department of Anesthesiology Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Healthand Wuhan Clinical Research Center for Geriatric AnesthesiaTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei ProvinceChina

Activated G-protein-coupled receptor 39(GPR39)has been shown to attenuate inflammation by interacting with sirtuin 1(SIRT1)and peroxisome proliferator-activated receptor-γcoactivator 1α(PGC-1α).However,whether GPR39 attenuates neuropathic pain remains *** this study,we established a Sprague-Dawley rat model of spared nerve injury-induced neuropathic pain and found that GPR39 expression was significantly decreased in neurons and microglia in the spinal dorsal horn compared with sham-operated *** injection of TC-G 1008,a specific agonist of GPR39,significantly alleviated mechanical allodynia in the rats with spared nerve injury,improved spinal cord mitochondrial biogenesis,and alleviated *** changes were abolished by GPR39 small interfering RNA(siRNA),Ex-527(SIRT1 inhibitor),and PGC-1α*** together,these findings show that GPR39 activation ameliorates mechanical allodynia by activating the SIRT1/PGC-1αpathway in rats with spared nerve injury.

关键词： G-protein-coupled receptor 39(GPR39) neuroinflammation neuropathic pain nuclear respiratory factor 1(NRF1) peroxisome proliferator-activated receptor-γcoactivator 1α(PGC-1α) sirtuin 1(SIRT1) spinal cord mitochondrial transcription factor A(TFAM)

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Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 2194-2201页

作者： Shu-Shu Song Li Lin Li Li Xiao-Dong Han department of anesthesia and Surgery Wenzhou Central HospitalWenzhou 325099Zhejiang ProvinceChina

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in *** treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical ***,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient *** To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver *** Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was ***-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general *** were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration *** EA occurred in 51(25.5%)*** analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test ***-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed

关键词： Primary hepatocellular carcinoma resection General anesthesia Emergence agitation Risk factors Forecast Nomograph

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Latest assessment methods for mitochondrial homeostasis in cognitive diseases

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Neural Regeneration Research 2024年第4期19卷 754-768页

作者： Wei You Yue Li Kaixi Liu Xinning Mi Yitong Li Xiangyang Guo Zhengqian Li department of Anesthesiology Peking University Third Hospital Peking University Third Clinical Medical College Beijing Center of Quality Control and Improvement on Clinical anesthesia anesthesia and Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care(CPAM)

Mitochondria play an essential role in neural function,such as supporting normal energy metabolism,regulating reactive oxygen species,buffering physiological calcium loads,and maintaining the balance of morphology,subcellular distribution,and overall health through mitochondrial *** the recent technological advances in the assessment of mitochondrial structure and functions,mitochondrial dysfunction has been regarded as the early and key pathophysiological mechanism of cognitive disorders such as Alzheimer’s disease,Parkinson’s disease,Huntington’s disease,mild cognitive impairment,and postoperative cognitive *** review will focus on the recent advances in mitochondrial medicine and research methodology in the field of cognitive sciences,from the perspectives of energy metabolism,oxidative stress,calcium homeostasis,and mitochondrial dynamics(including fission-fusion,transport,and mitophagy).

关键词： cognitive disorders mitochondrial dysfunction mitochondrial energy metabolism mitochondrial dynamics mitochondrial transport mitophagy mitochondrial biogenesis oxidative stress calcium homeostasis

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Epidemiological and Computed Tomography Aspects of Facial Trauma at Kira Hospital in Bujumbura

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Open Journal of Radiology 2024年第2期14卷 83-91页

作者： Sébastien Manirakiza Jean Marie Banziriyubusa Stany Harakandi Patrice Barasukana Chantal Murekatete Daniel Nduwayo Jean Bosco Bizimana Léopold Nzisabira department of Radiology Teaching Hospital of Kamenge Bujumbura Burundi department of anesthesia and resuscitation Teaching Hospital of Kamenge Bujumbura Burundi department of Internal Medicine (Neurology) Teaching Hospita lof Kamenge Bujumbura Burundi department of Surgery (Neurosurgery) Teaching Hospital of Kamenge Bujumbura Burundi

Background: Maxillofacial trauma affects young adults more. The injury assessment is difficult to establish in low-income countries because of the imaging means, particularly the scanner, which is poorly available and less financially accessible. The aim of this study is to describe the epidemiological profile and the various tomodensitometric aspects of traumatic lesions of the face in patients received in the Radiology department of Kira Hospital. Patients and methods: This is a descriptive retrospective study involving 104 patients of all ages over a period of 2 years from December 2018 to November 2019 in the medical imaging department of KIRA HOSPITAL. We included in our study any patient having undergone a CT scan of the head and presenting at least one lesion of the facial mass, whether associated with other cranioencephalic lesions. Results: Among the 384 patients received for head trauma, 104 patients (27.1% of cases) presented facial damage. The average age of our patients was 32.02 years with extremes of 8 months and 79 years. In our study, 87 of the patients (83.6%) were male. The road accident was the circumstance in which facial trauma occurred in 79 patients (76% of cases). These injuries were accompanied by at least one bone fracture in 97 patients (93.3%). Patients with fractures of more than 3 facial bones accounted for 40.2% of cases and those with fractures of 2 to 3 bones accounted for 44.6% of cases. The midface was the site of the fracture in 85 patients (87.6% of cases). Orbital wall fractures were noted in 57 patients (58.8% of cases) and the jawbone was the site of a fracture in 50 patients (51.5% of cases). In the vault, the fractures involved the extra-facial frontal bone (36.1% of cases) and temporal bone (18.6% of cases). Cerebral contusion was noted in 41.2% of patients and pneumoencephaly in 15.5% of patients. Extradural hematoma was present in 16 patients and subdural hematoma affected 13 patients. Conclusion: Computed tomography is

关键词： Road Accident CT-Scan Facial Trauma

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Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1582-1591页

作者： Xing-Jun Wang Xi-Chen Xuan Zhao-Chu Sun Shi Shen Fan Yu Na-Na Li Xue-Chun Chu Hui Yin You-Li Hu department of anesthesia and Perioperative Medicine The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210029Jiangsu ProvinceChina

BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain *** To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative *** A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in *** factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas *** was defined as sustained mean arterial pressure30 min despite additional deoxyepinephrine and fluid *** Among 1596 PD patients,661(41.42%)experienced *** logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).

关键词： Risk factors Pancreaticoduodenectomy Perioperative period Intraoperative persistent hypotension Retrospective cohort study

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