Review of Anesthesia for ENT, Oral and Maxillofacial Surgery at the National Hospital of Niamey: Situational Analysis in Limited Resource Setting
Author(s): Boukari BM, Maikassoua M, Rabiu MB, Magai A, Abdoulaye MB, Adakal O, Niandou MA, Moussa MR
Otorhinolaryngology (ENT) and maxillofacial surgery (MFS) have unique anaesthetic challanges, the main anesthetic concern is sharing of airway. The aim of this work is to determine the demographic and clinical chracteristic of patients in the ENT and MF units at the Niamey National Hospital operated under the period of review.
This was a prospective cross-sectional and descriptive study running from January 1 to June 30, 2020. Our study included all patients operated on ENT and MFU during the study period. The parameters studied were socio-demographic, the practice of anesthesia, perioperative critical incidence.
During our study, 147 patients were included out of 2082 admitted to the Niamey National Hospital, accounted for 7.06% of toatal patients admitted during the study period. ENT accounted for 93 patients and CMF 54. The mean age of our patients was 22 ± 10 years with extremes of 11 months and 85 years. The male to female ratio was 2:1. Surgery was urgent in 14.29% of cases and 46.26% of the patients were referred. Tonsillectomy was the most common indication for ENT procdure. Difficult intubation criteria were detected in 34 patients. The ASA 1 class was in the majority (70.07%). The mean wait time for the entire study population was 5 weeks and 5 days with extremes of 0 days and 486 days. Premedication was indicated among 38 patients, diazepam was the drug administered. All patients had received Rocephine as antibiotic prophylaxis. General Anaesthesia with Endotracheal intubation was the anesthetic technique among 84 patients 90.03% for ENT and 48 patients accounted for 88.8%. Propofol, thiopental, ketamine, and halothane were used as induction and mantainance of anaesthesia. Fentanyl was the only opioid drug. All our patients were extubated on a table with an average duration of anesthesia of 106 minutes with extremes of 20 minutes and 600 minutes. The incident reported intraoperatively was 11 cases of bleeding. The postoperative period was marked by the occurrence of bronchospasm during extubation in 11 patients and arterial hypotension in 3 others, no mortality was been recorded. In 97.96% of cases, the anesthetic team was made up of Senior Technicians in Anesthesia and Resuscitation, Physician Anaesthetist under the supervision of a consultant anesthetist.
This study demonstrated that safe anaesthesia can be administered for ENT and maxillofacial surgeries in limited resource setting and surgical mortality and morbidity can be reduced, through judicious use of available resources, team work and vigilance