ABSTRACT
Purpose: The use of antibiotic prophylaxis in surgery is to prevent infection of the surgical wound. Although its principles follow specific guidelines, inappropriate practice is often observed. The aim of this study is to evaluate the use of prophylactic antibiotics in the operating room of the RH of Maradi (Niger). Methodology: This was a prospective and descriptive study done over a period of 12 months; from the 1st of January to December 31, 2020. We studied patients admitted to the operating rooms for Surgical Wound Classification (SWC) I and II scheduled surgeries. Results: We collected 286 patients of which 68.53% were male with a mean age of 27.1 years. Patients were SWC I and II. Abdominal,genito-urinary and ortho-trauma surgeries were the most performed. 96.15% of patients received antibiotic prophylaxis. Six patients were already on antibiotics and five patients received none. Ceftriaxone was the most widely used drug. The delay between administration and incision was 30 min or more in only 6.18% of patients. More than half of our patients had received the antibiotic less than 30 min before the incision (57.81%). Postoperative complications were infectious in 60% of cases, 80% of which were surgical site infections. Infectious complications occurred in patients who received their 1st round of antibiotics after incision and the rest within 15 min which preceded the incision. Conclusion: Strict and rigorous respect of preoperative antibiotic prophylaxis protocols in the operating room is a daily challenge, while the fight against nosocomial infections and bacterial resistance remains a major concern.

ABSTRACT
Guillain–Barre´ syndrome (GBS) is an acute demyelinating disease and the most common cause of acute flaccid paralysis (AFP). We report a case of Guillain-Barré syndrome associated with corona virus which is a novel virus. At presentation the patient was hypoxic and was intubated in view of high oxygen requirement. He was weaned off from ventilator but there was extubation failure. He was reintubated. Other causes of extubation failure were ruled out. His motor power was 1/5 in upper limb, 0/5 in lower limb along with autonomic involvement. He was diagnosed with GBS. He was tracheostomised and managed with dual session of IVIG (intravenous immunoglobulin) and 3 sessions of plasmapheresis. Patient’s motor power improved. He was weaned off from ventilator and decannulated. Motor power improved to 5/5 in upper limb and 3/5 in lower limb and he was discharged on room air.

ABSTRACT
Critical illness is characterized by substantial hormone- and cytokine-mediated protein metabolism changes in various organs, leading to increased breakdown and decreased synthesis rates. Consequently, a considerable and life-threatening loss of muscle mass occurs. Medical therapeutic measures such as long-term sedation and mechanical ventilation during ICU stay can further enhance this muscle degradation (up to 2 % muscle mass per day leading to clinically relevant symptoms known as ICU-acquired weakness, a clinical symptom that is classified as a secondary disorder. If left unabated, these circumstances might strongly affect long-term patient outcomes. This study consists of 20 mechanically ventilated patients expected to stay in the intensive care unit (ICU) for at least 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality. In this prospective randomized controlled trial, we found that a high protein intake and resistance training led to an improvement in the physical quality of life of critically ill patients as measured by the PCS score after 3 and 6 months. We also found a reduction in mortality rate and a tendency to improvement in the ICU-acquired weakness measured through handgrip strength in the study group.

ABSTRACT
Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cava syndrome (a complication of some forms of cancer), and along with antibiotics in tuberculosis. The major finding in this study was that for women who underwent cesarean delivery under spinal anesthesia that included intrathecal morphine, a single dose of dexamethasone 8 mg IV administered prior to skin incision did not reduce postoperative analgesic consumption or pain scores. Fifty women were enrolled and randomized to two groups of 25 patients. The median (IQR) opioid consumption in the first 24 hours after cesarean delivery was 12.5 mg (5-20 mg) in the dexamethasone group compared to 13.5 mg (5-22 mg) in the placebo group. The median difference in opioid consumption at 24 hours (94% CI) was -3 mg (-12.2 to 5.7) and was not significantly different between groups.

ABSTRACT
Background: Use of multiple anesthetic agents to induce anesthesia is not new and they are used to achieve different effects such as sedation, muscle relaxation and pain relief. Thiopentone is the most widely used intravenous induction agent in current anaesthetic practice. Propofol is a new rapidly acting intravenous anaesthetic. The rapid redistribution and metabolism of propofol, result in a short elimination half-life. Midazolam is an imidazobenzodiazepine with relatively rapid onset of action and high metabolic clearance compared to other benzodiazepine. Objectives: T compare the induction characteristics of thiopentone, midazolam and propofol in elderly patients. Methods: A prospective randomized, double blind control study was conducted in the department of Anaesthesia at Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from January to December-2020. Sixty three adult patients, aged between 55-75 years with ASA grade I & II Who were clinic trial in our department. The patients were divided into three groups of 21 each according to a randomization table. The overall performance of the drugs were assessed by recording the following parameters: 1. Pain on injection. 2. Induction time (The time from start of injection to the loss of eye lash reflex). 3. Coughing 4. Involuntary motor activity. 5. Apnoea (present/absent). 6. Haemodynamic changes (Heart rate and blood pressure at 2 min before injection, after induction and 1min, 3min and 5min after intubation). 7. Recovery time (From the end of reversal until the patient responded to vocal command (eye opening, tongue protrution). Results: The incidence of pain on injection was greater in propofol group (42.86%), which was statistically significant (p<0.01). The induction time was significantly longer (p<0.001) in the midazolam group. Incidence of excitatory effects was more common in propofol group (p<0.05). Incidence of apnoeic episodes were significantly greater in thiopentone and ............

ABSTRACT
Caesarean section is a surgical operation consisting of extracting the fetus by incising the abdominal wall and uterus. It is a high-risk act for both the mother and the fetus, it is increasingly performed and often in an emergency. We present the indications, epidemiological profile and feto-maternal prognosis of the emergency caesarean section. This is a prospective, descriptive and analytical study covering a period of one month (June 1 to 30, 2021). The study took place at the Mother and Child Health Center in the Zinder region. Included in the sample were any parturient admitted directly or after evacuation of other emergency caesarean section sanitary facilities and excluded those received for any indication other than emergency caesarean section. The variables studied were epidemiological data, caesarean section indication, ASA class, anesthetic technique, admission - fetal extraction time, operating time, fetal-maternal complications, maternal prognosis. The data collection was made from the patient record, the operating room register and a questionnaire sent to the patient at admission. Fifty-five (55) files were selected and the average age of the parturients was 28 years with extremes of 15 years and 40 years. The 26 to 30 year olds were the most affected (27.27%). Most were of class ASA I (65.45%). Primigests accounted for 20% of cases, 2nd and 3rd gestures constituted 40% and multipares 20% of cases. Spinal anesthesia was the most practiced anesthetic technique 70.90% versus 18.18% for general anesthesia. Fetal suffering was the most common operating indication with 14.54% of cases followed by vicious presentation (siege, feto-pelvic disproportion) in 10.90% and 09.09% of cases, respectively. The average time induction anesthetic fetal extraction was three (3) minutes and that of the procedure was forty (40) minutes. The surgical suites were simple both maternal and for the sixty newborns.

ABSTRACT
Huge fibroids are common presentations in our institutions. Abdominal myomectomy is the commonest method of treatment for those women. Preoperative anemia from menorrhagia and hemorrhage during myomectomy increases the need for perioperative homologous blood transfusion with its potential complications and risk for perioperative morbidity and mortality. The anesthetic technique that can reduce perioperative blood loss should be considered because of the reported association between anaesthesia type and risk of perioperative blood loss. All patients who had elective abdominal myomectomy for huge fibroids using the two main methods of anaesthesia (Regional (RA) and General (GA)) from January 2012 - December 31 2016 were retrospectively studied for type of anaesthesia, blood loss, need for blood transfusion and number of units of blood transfused. The technique was considered appropriate if it was a RA technique and was associated with a lesser blood loss, transfusion requirement and lower total number of units of transfused blood. Three hundred and fifty three (353) patients met the study’s inclusion criteria. One hundred and fifty (42.5%) patients had GA, while 203(57.5%) had RA. Mean blood loss was higher in the GA group compared to the RA group 593.2±486.6 and 410.8±316.7 respectively. Forty two patients in the GA group had a total of 57 units of blood while 23 patients in the RA group received a total of 29 units of blood preoperatively. Regional anesthesia was associated with significantly less blood loss and blood transfusion. Its use for myomectomy for huge uterine fibroids is very appropriate and should to be sustained.

ABSTRACT
Endotracheal tube (ETT) cuff hyperinflation can cause inflammation of the endotracheal layer; ischemia or necrosis of the tracheal wall and under expansion increases the risk of lung aspiration, anesthetic gas leaks, and environmental pollution increase. Intubation is routinely performed during general anesthesia. Maintain proper cuff pressure when inflating the endotracheal tube (ETT) cuff, as serious adverse events can occur at both too high (positive) and low (negative) cuff pressures. It is important to do. In the present work an attempt had been made to evaluate the efficacy of ETT cuff pressure measurement using conventional clinical method of digital palpation of pilot balloon by comparing with instrumental method using standard cuff pressure manometer.