Practice of Pediatric Anesthesia in Sub-Saharan Africa: Experience of Two Referral Hospitals in Benin

Abstract

Introduction: The practice of pediatric anesthesia present particular risks and requires specifically trained staff. We describe here the practice of pediatric anesthesia in two referral hospitals of Cotonou. Method: This was an observational study conducted over a period of 05 months from August 4 to December 31, 2020. All children who had undergone an anesthetic procedure in these reference hospitals of Cotonou during the study period and who met the inclusion criteria were recruited. Data collection was carried out by filling out an individual physical form for each child on whom a surgery was performed. Children who underwent surgery were followed up until their discharge from hospital and called back 30 days later. Results: A total of 345 patients were registered. Among them, 224 (64.9%) were male, for a sex ratio of 1.85. The average age was 55 months±4 months with extremes of one day and 190 months. Medical history was found in 9.56% of cases, and in 80.90% of cases, most interventions were scheduled. Digestive surgery was the most common (30.1%). The ASA1 class was the most represented (73.04%). The practice of pediatric anesthesia was medicalized in 17.39% of cases. All children were monitored. General anaesthesia was the most commonly used anaesthesia technique (89.85%). Loco-regional anaesthesia techniques were less used (27.53%). Spinal anesthesia (11.90%) and caudal anesthesia (11.30%) were the most commonly used local anesthesia techniques. The prevalence of anesthetic incidents and/or accidents during our study was 23.7% with a rate of 29 cardiac arrests per 10,000 anesthetics and an intraoperative mortality rate of 29 per 10,000 anesthetics. Perioperative complications were dominated by respiratory complications (11.57%), followed by cardiovascular complications (8.68%) and neurological complications (6.95%). A total of 84.35% of our patients were referred to an immediate post-interventional monitoring unit. I recorded 13 deaths in the postoperative period, representing a mortality rate of 3.7%. Conclusion: This work shows that the practice of pediatric anesthesia in Benin compared to previous years is becoming more and more satisfactory, even if the anesthetic safety is not yet optimal. It seems imperative to favor the specialization of practitioners, to promote loco-regional anaesthesia and to create pediatric hospitals with adapted resuscitation rooms and operating theaters.