Anesthesiological Management of Acute Generalized Peritonitis at Chu Kara

Abstract

The aim of our work was to make an inventory of the anesthesiological management of acute generalized peritonitis at the CHU-Kara. To determine the frequency of acute generalized peritonitis; to describe their treatment in pre, per and postoperative; to analyze the postoperative follow-up. This work was a retrospective descriptive study carried out on the files of patients operated for acute generalized peritonitis from November 1, 2019 to October 31, 2020. The study was performed in the surgical resuscitation department and in the operating room. Fifty-eight cases of generalized peritonitis were selected for the study. Peritonitis represented 27.8% of abdominal surgical emergencies. The patients were male dominated with a mean age of 29.6 years. The average consultation time was 3.5 days. Fever was the predominant clinical sign on admission (72.4%). The average duration of preoperative resuscitation was 17 hours and 18 minutes. The combination of Ceftriaxone and Metronidazole was the most used antibiotic therapy. General anesthesia was standard. Spinal anaesthesia was the second technique used. Preoxygenation was systematic for general anesthesia. Pancuronium (72.2%) was the most used curare. The average duration of anesthesia was 105 minutes. Laparotomy, peritoneal cleansing and drainage were performed in all patients, followed by excision-suture of the stomach (43.1%). Peritonitis due to peptic ulcer perforation predominated (43.1%) followed by typhoid perforation of the small intestine (24.1%). The morbidity rate was 41.4%, dominated by parietal suppurations (15.5%). The mortality rate was 8.6%. The average length of stay in intensive care was 8.7 days. The anesthesiological management of acute peritonitis remains a real challenge for anesthesiologists, given the major volume disturbances, the delay in diagnosis with its corollary of septic shock, and the lack of qualified personnel with which they are faced. Peritonitis is a real public health problem because of its still very high mortality. It was carried out with insufficiencies related to the poverty of the population, the inexistence of universal health insurance, the insufficiency of the technical platform and the insufficiency of organization.