ABSTRACT
Background: Clonidine stimulates the α2 receptors of the sympathetic nervous system which have a negative presynaptic feedback effect inducing a reduction in the secretion of adrenaline and noradrenaline. The main objective of our study was to evaluate the beneficial effects of clonidine on the hemodynamic response to surgical incision. Patients and Methods: This was a prospective, single-center, randomized, single-blind clinical trial that took place over a period of 4 months in the anesthesia department of the Essos hospital center in Yaoundé. All patients over the age of 18, ASA I or II, admitted for scheduled surgery were included in the study. The patients were randomly divided into two groups by drawing lots: group A (clonidine) and group B (non-clonidine). All patients in group A received clonidine IV (3μg/kg). Heart rate, systolic blood pressure, and diastolic blood pressure were observed at different times during the surgical procedure. Results: During the study period, 35 met the inclusion criteria: 20 patients for group A and 15 patients for group B. The average age was 34 years. The sex ratio was in favor of the male gender in both groups: 2.3 in group A and 2.7 in group B. ASA class 1 was the most represented (74.3%); visceral surgery most performed of all specialties in the two groups 55% (n=11) for group A and 53% (n=8) for group B. The systolic and diastolic arterial pressure curves are parallel in the two groups. There is a slight variation in PAS and PAD in group A "clonidine" compared to the baseline values. A tendency towards systolic arterial hypertension is observed in the “non-clonidine” control group. The heart rate remains stable in group A, while tachycardia is observed at the same time for the participants in group B. Conclusion: Clonidine is an alpha 2 adrenergic receptor agonist which makes it possible to limit the hypersecretion of catecholamines, potentially deleterious for the fragile patient, at the surgical incision.

ABSTRACT
Introduction: Direct oral anticoagulants (DOA) are recent drugs prescribed for their anticoagulant properties. When an invasive procedure is planned for a patient under DOA, the challenge for the anaesthetist is to assess the risk of bleeding and thromboembolism secondary to the medication withdrawal. In certain situations, ultrasound, with its advantages of guidance and location, is an important tool that can reduce the peri-procedural bleeding risk. Method: We illustrate this problem with this clinical case. Observation: This is an 18-year-old female patient with a history of recent deep vein thrombosis treated with direct oral anticoagulants in an underlying pulmonary tuberculosis condition under treatment; received in the intensive care unit for management of respiratory distress due to a hydro-pneumothorax confirmed on pleuropulmonary ultrasound. Amain this urgent indication for thoracic drainage, the patient benefited from a decision by the referral team to withdraw the DOAs for 3 days, a relay with curative LMWH, an exsufflation of the pneumothorax and an evacuation puncture of the effusion under ultrasound guidance and location. Chest drainage was performed successfully and uneventfully after 3 days of DOA withdrawal. Conclusion: When an invasive procedure has to be performed in the emergency department or when the thromboembolic risk is very high, validated strategies for the peri-procedural management of DOAs have not been the subject of consensus. Our case-report highlighted the value of thoracic ultrasound in the intensive care unit, which facilitates the performance of minimally traumatic procedures in the emergency department. This tool allows to postpone a procedure of bleeding risk while promoting good drug management.

ABSTRACT
Background: Pulmonary embolism (PE) is a blood clot that blocks and stops blood flow to an artery in the lung. It (PE) is a common and often fatal complication of venous thromboembolic disease (VTE). Pulmonary embolism (PE) is the third leading cause of cardiovascular-related death and is responsible for the hospitalization of a huge number of patients yearly. D-dimer concentration is a diagnostic marker of pulmonary embolism (PE). Aim of the study: This study aimed to assess the impact of anesthesia on D-dimer concentration in patients undergoing surgery associated with high risk for pulmonary embolism. Methods: This prospective observational study was conducted in the Department of Anesthesia & ICU, Mugda Medical College Hospital, Dhaka, Bangladesh during the period from January 2022 to December 2022. In total 57 patients undergoing surgery associated with a high risk for pulmonary embolism were enrolled in this study as study subjects. In this study, we examined the changes imparted by anaesthesia surgery on the end-tidal CO2/O2 compared with the D-dimer. Blood samples were immediately analyzed for fibrinogen and D-dimer concentrations. Breath samples were obtained from 1 min of spontaneous tidal breaths delivered via mouthpiece while the patientst breathed room air. Results: In this study, the mean transoperative value changes of respiratory rate (breaths/min), pulse rate (beats/min), systolic blood pressure (mmHg), SaO2 (%, room air) and minute ventilation (ml/min) were found as 0.23, 11.2, 15.33, 2.05 and 779.42 respectively. The pre-operative mean D-dimer 1042.57 ±202.47 ng/ml had been significantly increased to 1277.58 ±211.28 ng ml postoperatively, where the p-value was found as <0.001. On the other hand, the pre-operative mean End-tidal CO2 ⁄ O2, 0.3 ±0.02 had been decreased to 0.3 ±0.01 (Not significant). But the mean fibrinogen (mg/dl) had increased significantly (p<0.001). Conclusion: As per the findings of this study we can conclude that the stress ...

ABSTRACT
Objectives: To study antibiotic prophylaxis in Niamey. Patients and Methods: A cross-sectional multicenter study conducted in five hospitals in Niamey over a period of four months from 16th June, to 15th, October, 2021. The study included anaesthetists, anaesthesia nurses, surgeons, surgeon nurses and surgical unit supervisor, who agreed to complete the survey supports. The variables studied were: age, profession, experience of practitioners, knowledges of surgery requiring antibiotic prophylaxis and duration, choice and prescription of antibiotics, need for post degree training. Results: Were been included 146 practitioners: 53 anaesthesia nurses, 31 surgeons, 30 surgeons nurses, 22 surgical unit supervisor and 10 anaesthetists. Their average age of practitioners was 40.85 years, ranging from 24 to 59 years. The study found that preventing infection was the goal of antibiotic prophylaxis for 91.78% of practitioners. Surgeries requiring antibiotic prophylaxis were clean and contaminated surgeries according to 64.38% and 56.84% of staff, respectively. The prescriber of antibiotic prophylaxis should be the anaesthetist according to 61.64% of respondents. The antibiotic should be administered 30 minutes before the incision for 56.85% of practitioners. Ceftriaxone was the most proposed antibiotic in 43.15%. Eighty-three percent of staff had not received after degree training on antibiotic prophylaxis. Conclusion: this study reveals the inadequacies of surgical antibiotic prophylaxis in Niamey hospitals. The difficulties are related to the unavailability of recommended antibiotics, the lack of protocol and the lack of training.