ANESTHESIA PRACTICE IN LOW- INCOME COUNTRY: A MULTICENTRIC STUDY - Abstract
Objective: The aim of this study was to evaluate anesthesia practice in low-income country (Niger case)
Methods: This is a multicenter, prospective and observational study over a period of 7 days from 9th to 15th January, 2019, carried out in national hospitals, regional hospitals, mother and child centers and district hospitals in Niger. Included were all patients admitted to the selected centers who had received an anesthetic procedure. The following variables were analyzed: age, sex, hospital structures and equipment, anesthesia staff, indication of surgery, technique of anesthesia, type of surgery, the qualification of the anesthesiologist,
American Society of Anesthesiologist (ASA) physical status classification, indicatins of the surgery, critical incidents, postoperative follow-up. This follow-up was until the discharge of patients who had been hospitalized for less than a month. It was one month for patients whose hospital stay exceeded one month.
Results: The series included 802 patients, 482 women (60.10%) and 320 men (39.90%); or a sex ratio of 0.66. Patients were classified ASA1 in 66.5 % and Mallampati 1 in 80.30% of cases. Anesthesia was performed by anesthetist nurses in 91% of patients and by the anesthetist in 9% of patients. General anesthesia was the most used technique with 53.12%, followed by spinal anesthesia with 41.40%. For the induction of general anesthesia, the intravenous hypnotics used were ketamine (36.6%) and propofol (22.52%). Maintenance was provided with halothane in 58.22% of patients. Regarding spinal anesthesia, the bupivacaine-fentanyl combination was the most used; 65.06% of cases. The most performed types of surgery were cesarean section with 33.69% followed by digestive surgery; 32.16%. Emergency surgery concerned 61% of patients. Accident incidents were encountered in 5.49% of patients with a predominance of bradycardia (2.74%). Mortality was 0.99%.
Conclusion: The practice of anesthesia in low-income country still suffers from shortcomings compared to international standards. The improvement of this situation requires the training in sufficient numbers of anaesthetists, the judicious distribution of qualified personnel throughout the national territory and the equipment of hospitals in materials and drugs for anesthesia.