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Introduction: Pulmonary embolism (PE) is a life-threatening condition that represents a major challenge in the management of patients in intensive care. Despite recent advances in prophylactic, diagnostic and therapeutic modalities, PE remains an important cause of morbidity and mortality. Hence the interest of this retrospective study on the management of pulmonary embolism of patients hospitalized in the resuscitation unit of the Peace Hospital of Ziguinchor. Methodology: We conducted a retrospective, descriptive and analytical study covering a period of 32 months from September 2020 to May 2023. The data included variables such as age, gender, clinical symptoms, results of paraclinical tests and treatments administered. Results: The sex ratio was 1.72 with a majority age group of 40-59 years. The average age was 58.93 years for a median age at 58 years. Prolonged immobilization greater than 3 days was the risk factor most found in our patients 33.3% followed by hypertension in 13.3%. Respiratory distress is the main reason for hospitalization in 66.7%. The intermediate clinical probability was most found in our population with 90%. In 53.3% of our patients, the lung damage was unilateral against bilateral for 23.3% at CT-scan. Admission shock was found in 6.7%. In 43.3%, amines were used including noradrenaline at 26.7% and dobutamine at 20%. LMWH were the anticoagulants used in all patients followed by VKA (Acenocoumarol) with 40%. Only 6.7% of our patients were thrombolysed. Mortality was 63.3%. The prognosis according to the PESI score is 53.3% for class 5 and the progressive modalities were poor in 70% of cases. Conclusion: The factors of poor prognosis found are disorders of consciousness, respiratory failure and PESI class 5. This study highlights the urgency of strengthening initiatives for the prevention, diagnosis and treatment of PE. It is vital to work to improve access to thrombolysis in order to reduce mortality and improve quality of life for ......

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Aim of the study: To assess the knowledge and attitudes of anesthesia staff on the management of pain in the hospitals of Niamey. Patients an method: This was a multicenter descriptive cross-sectional study carried out in five hospitals in Niamey (Republic of Niger) from July 3rd to December 3rd, 2021. Were been included in the study, all the anesthesia staff who agreed to answer the questionnaire. The variables studied were: age, gender, seniority, sector of activity and qualification, definition of pain, different types of pain, the impact of pain on the body, tools used for assessment of pain, difference between acute and chronic pain, knowledge about analgesics, the practical attitudes of pain management. The data were intered and processed with Epi info 7.2 software and the Microsoft Office 2019 pack. Results: Our study concerned 106 agents from the anesthesia and resuscitation department of the hospitals that served as our study framework. There is a female predominance of 55.42% with a sex ratio of 0.80. The 45-54 age group was the most represented with 40.07% of cases. The average age of respondents was 44.95 ± 8.9 years. Anesthesia nurses were the most represented with 90.36%. The operating theatre unit was the most represented sector of activity with 85.54%. All the respondents knew the definition of pain. The different types of pains were known by 45.78% of respondents. The most used pain scales were visual analog scale (VAS) and verbal descriptor scale (VDS) respectively in 53.01 % and 12.05 % of cases. Tramadol and paracetamol were the mostly used analgesics respectively in 98.80 % and 97.59%. Intravenous morphine titration was known to 67.47% of the respondents. Only 18.07% of the respondents benefited from a training on the management of pain. Conclusion: The knowledge and attitudes of anesthetists on pain deserve to be updated through theorical and practical training to improve the management of pain in our hospitals.

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Aim of the study: To study the risk factors and the clinical consequences of perioperative hypothermia in pediatric surgery. Patients and Method: It was an observational and descriptive prospective study conducted over a period of two (2) months from December 10th, 2021 to February 10th, 2022. Were inclueded in the study children from 0 to 15 years old who were done general anesthesia with tracheal intubation in a elective surgery that lasted 30mn at least. The variables studied were: age, gender, American Society of Anesthesiologists (ASA) status, type of surgery, the means used for prevention, perioperative incidents, intraoperative transfusion, patient’s temperature before induction and during surgery until extubation, duration of the surgery, duration of anesthesia. Results: During the period of our study, 89 patients were collected. The average age was 4,79 ± 3,53 years with extremes of 14 days and 15 years. The most represented age group was that of 1 month to 5 years with 61% of cases. Male gender represented 66.29% of cases, a sex ratio of 1.96. Perioperative hypothermia was noted in 64.04% of the patients, it was moderate in 95% of cases and severe in 3% of cases; all the age groups were concerned but newborns were the most susceptible. The room temperature fluctuated around an average of 27 ± 2,7°C with extremes of 24.6°C and 30°C. Digestive surgery predominated with a frequency of 57.30%. ASA I was the most represented class in 65% of cases. Risk factors were age, the type of surgery, a high ASA level, duration of the surgery and blood transfusion. All the patients who received transfusion presented hypothermia. The most common consequences of perioperative hypothermia were wake-up delay in 35% and bradycardia. Conclusion: Perioperative hypothermia is very common in pediatric surgery. Then, it should be prevented effectively to avoid its complications.

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Introduction: The transverse abdominal plane block or TAP block consists of injecting a local anaesthetic between the internal oblique and transverse muscles. Its contribution to muscle relaxation during laparoscopic surgery has been little studied. Material and Method: We carried out a 2-years prospective, descriptive and analytical randomised study blinded to the surgeon conducted in the operating theatre of the Saint Louis Regional Hospital Centre. Patients were randomised into two groups: those who received vecuronium after rapid sequence induction (group V) and those who received bilateral TAP block without curares (group T). Anamnestic, clinical, anaesthetic, surgical and evolutionary aspects were collected and analysed. The main evaluation criteria were: pneumoperitoneum pressure, exhaled CO2, respiratory motor pressure and surgeon satisfaction scale. Results: We collected 61 patients admitted for laparoscopic abdominal surgery. The mean age was 32.9 years with a standard deviation of 14.5. Appendicitis was the indication in 55% of cases. The Propofol-celocurine-TAP-block anaesthetic protocol was used in 25 patients, i.e. in 41% of cases, and 59% of patients had undergone a conventional induction using vecuronium. The mean pressure of the pneumoperitoneum was 11.3 mmHg for the conventional induction group and 12.6 mmHg for the TAP-block group. The mean respiratory motor pressures were 12 cmH2O for the conventional induction group and 13.7 cmH2O for the TAP-block group. The mean value of exhaled CO2 was 37.5 mmHg. Fentanyl reinjections were more frequent in the conventional induction group in 55.6% of cases. The mean VAS at 6 hours post-op was 4.5 for the conventional induction group and 3 for the TAP-block group. Discussion/Conclusion: The ultrasound-guided trans-abdominal-pelvic block remains an effective, durable and reproducible technique. Its advantages in terms of postoperative analgesia are well known. In addition, its selective effects on muscle ......

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IgG4 Related Disease (IgG4 RD) is a comparatively new multisystem disorder associated with elevated levels of IgG4. It includes a number of disorders which were previously thought to be idiopathic or autoimmune. This is a rare condition and can affect any organ system in the body with IgG4 Related pachymeningitis having even lesser incidence. In this case report we present a patient who had chronic low back ache, who on evaluation was found to have a mass compressing on the spinal cord at the thoracic level, requiring surgical decompression. Biopsy and immunological testing were suggestive of IgG4 related pachymeningitis. We describe the diagnosis, medical management, and follow up of this patient, with discussion on how timely diagnosis and management will help in preventing further episodes and help in recovery. This case reiterates about medical conditions presenting as tumor mimics.

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Background: Shivering is a common and distressing complication during cesarean sections performed under spinal anesthesia, posing risks to both maternal and fetal well-being. Effective shivering prevention is essential to enhance perioperative outcomes. Intrathecal fentanyl and intravenous ondansetron are commonly used pharmacological agents for this purpose, yet their comparative effectiveness has not been conclusively determined. Objective: This study aimed to compare the efficacy of intrathecal fentanyl versus intravenous ondansetron in preventing shivering in full-term pregnant women undergoing cesarean section under spinal anesthesia. Method: A randomized controlled comparative study was conducted at SV Medical College, Tirupathi, Andhra Pradesh, between February 2023 and August 2023. A total of 250 full-term pregnant women scheduled for cesarean section were randomly assigned into three groups. Group F (n=83) received intrathecal fentanyl (15 μg) with spinal anesthesia, Group O (n=83) received intravenous ondansetron (8 mg) added to the usual saline solution, and Group C (n=84) served as the control, receiving only IV fluid and intrathecal bupivacaine without fentanyl. The incidence of shivering during the procedure was observed and recorded for all participants. Results: Shivering occurred in 15 of the 83 women in Group F, resulting in an incidence rate of 18.1%. In Group O, shivering was observed in 23 of the 83 women, corresponding to an incidence rate of 27.7%. The control group (Group C) exhibited the highest incidence, with shivering occurring in 38 of the 84 women, representing 45.2% of the group. The reduction in shivering incidence was statistically significant in Group F compared to both Group O (p<0.05) and Group C (p<0.01). Conclusions: Intrathecal fentanyl significantly reduces the incidence of shivering in cesarean sections under spinal anesthesia compared to intravenous ondansetron and no shivering prevention. With an incidence reduction of 59.9