Review of anesthesia for ENT, oral and maxillofacial surgery at the National Hospital of Niamey: situational analysis in limited resource setting

Abstract

Introduction: In otolaryngology and maxillofacial surgery, the main anesthetic problem is the management of the upper airways. The aim of this work is to take stock of anesthesiological activities in the ENT and CMF departments of the Niamey National Hospital. Methodology: This was a prospective cross-sectional and descriptive study running from January 1 to June 30, 2020. Our study included all patients operated on in ENT and stomatology during the study period. The parameters studied were socio-demographic, the practice of anesthesia, per- and postoperative incidents and accidents, anesthesia team and equipment. Result: During our study, 147 patients were included out of 2082 admitted to the Niamey National Hospital, accounted for 7.06% of toatal patients admitted during the study period. ENT accounted for 93 patients and CMF 54. The mean age of our patients was 22.29 years with extremes of 11 months and 85 years. The sex ratio was 0.67. Surgery was urgent in 14.29% of cases. 46.26% of the patients came from outside Niamey. Tonsillectomy was the most common indication. All patients admitted for completed surgery received CPA. Difficult intubation criteria were detected in 34 patients. The ASA 1 class was in the majority (70.07%). The mean wait time for the entire study population was 5 weeks and 5 days with extremes of 0 days and 486 days. Premedication was necessary in 38 patients. Diazepam was the drug administered. All patients had received antibiotic prophylaxis. Rocéphine was the molecule used. AG + IOT was 89.80% the anesthetic technique used. The hypnotics used were propofol, thiopental, ketamine, and halothane. Fentanyl was the only opioid drug. All our patients were extubated on a table with an average duration of anesthesia of 106 minutes with extremes of 20 minutes and 600 minutes. The incident reported intraoperatively was 11 cases of bleeding. The postoperative period was marked by the occurrence of bronchospasm during extubation in 11 patients and arterial hypotension in 3 others. No deaths have been recorded. In 97.96% of cases, the anesthetic team was made up of Senior Technicians in Anesthesia and Resuscitation alone, under the supervision of a resuscitator anesthetist. Conclusion: This study demostrated that safe anaesthesia can be administered for ENT and maxillofacial surgeries in limited resource setting and surgical mortality and morbidity can be reduced, through judicious use of available resources, team work and vigillance.