Anesthetic Management of Hepatic Resection in a Low-Resource Setting: First Bulletin from Africa

Abstract

Introduction: General anesthesia and antisepsis have made intraperitoneal surgery safer. With the improvement of anesthetic techniques and the development of new surgical approaches, the liver, an organ with high haemorrhagic risks, has become the subject of many successful therapeutic indications. Although widely performed in high-income settings due to a better technical platform, the reverse is true for low-resource settings in Africa where there is little or no report on the anesthetic management of this dreadful surgery. Hence, this study is one of the first from Africa to report on the perioperative anesthetic management and outcome of hepatic resections. Methods: This was a retrospective case series study conducted over four years (2019-2022) through a chart review of all medical and anesthesia records of patients admitted to Douala General Hospital, Cameroon for hepatic resection. We collected socio-demographic, clinical, laboratory and intraoperative data, the estimated financial cost and patient outcomes. Results: Twelve open hepatic resections were performed mainly electively (11/12 cases) for localized hepatic tumours (7/12 cases) on ASA II patients (11/12 cases) with a mean age of 36.5 years and sex ratio of 1.2. Pre-anesthetic consultations were usually done within 24 days before the surgery. General anesthesia maintained with sevoflurane was the mainstay anesthetic technic. Continuous hemodynamic monitoring with an arterial catheter was done. The blood-sparing strategy was based on tranexamic acid, calcium gluconate and controlled hypotension with an intraoperative transfusion rate of 33.33%. The cost of the procedures was well above the minimum wage in Cameroon but relatively cheap compared to the cost in high-income countries. No perioperative death was recorded. Conclusion: Our hepatic resections were managed with satisfactory blood savings, low morbidity and zero perioperative mortality. Overall, this study is the first to provide data on perioperative anesthetic management and outcomes of hepatic resection in Africa.