Anesthesia practice in collective emergency situations: Example of Togo army peacekeeping hospital

Abstract

Objective: To report on anesthesia activities at the Togo Armed Forces Hospital deployed to Kidal in northern Mali as part of the Minusma. Patients and methods: This is a retrospective descriptive study carried out from 1er March 2015 to 29 February 2020. Results: One hundred and six (106) patients were treated under anaesthesia, i.e. an average of 21.2 per year. The mean age was 28.9 years, with extremes of 4 and 57 years. The patients were predominantly male, with a sex ratio of 25.5. Military personnel accounted for 74% of patients. Traumatic emergencies were the most frequent (56.4%), including 42.3% war injuries. Trauma and visceral surgeries were the most common at 48.1% and 47.2%. 66.1% of patients were classified as ASA1u. General anesthesia with orotracheal intubation (GA + OTI) was used in 56.6%. Ketamine (68.4%) and Propofol (31.6%) were most commonly used. Rocuronium was used in 88.3% of cases, and Fentanyl was the only morphine used. All patients received minimal monitoring of blood pressure, pulse, electrocardiogram, oxygen saturation and capnogram. Twenty (20) % of patients received a transfusion of packed red blood cells; only one patient received a transfusion of lyophilized plasma. Tranexamic acid was used in 9.4% of patients. Multimodal analgesia was provided with Paracetamol, Nefopam, Ketoprofen and Morphine. Forty-two patients were evacuated after stabilization, 59.5% to level 3 (Dakar) and 40.5% to level 2+ (Bamako). Intraoperative complications were dominated by arterial hypotension (35.2%) and shivering (19.6%). We recorded 0.6% intraoperative deaths. Conclusion: The organization of anesthesia care remains a major challenge in areas with limited medical resources and in conflict zones. It is possible thanks to improved medical equipment and ongoing simulation of medical and paramedical staff in emergency and disaster medicine.