Anesthetic management and morbidity in thoracic surgery: Results of the first series in Togo

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Published Sep 27, 2023
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Vol. 101 No. 5 (2023): Tunis med may 2023

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Pikabalo Tchetike
Department of Anesthesia and Intensive Care, Teaching Hospital Sylvanus Olympio, Lome, Togo
Damessane Lamboni
Medico-surgical Clinic, Teaching Hospital Sylvanus Olympio (CHU-SO), Lome, Togo
Sarakawabalo Assenouwe
Department of Anesthesia and Intensive Care, Faculty of Health Sciences, Teaching Hospital of Kara, University of Kara, Togo.
Magnoudewa Poko
Medico-surgical Clinic, Teaching Hospital Sylvanus Olympio , Lome, Togo
Ernest Ahounou
National University Hospital Centre of Cotonou, Benin
Amouki S. Tresor Anate
Medico-surgical Clinic, Teaching Hospital Sylvanus Olympio , Lome, Togo
Kolme Dissoba
Department of Anesthesia and Intensive Care, Teaching Hospital Sylvanus Olympio, Lome, Togo
Hamza Doles Sama
Department of Anesthesia and Intensive Care, Teaching Hospital Sylvanus Olympio, Lome, Togo
Tabana Essohanam Mouzou
Department of Anesthesia and Intensive Care, Faculty of Health Sciences, Teaching Hospital of Kara, University of Kara, Togo.

Abstract

Introduction: Thoracic surgery is a specialty with specific anesthetic management requirements. This is a recent specialty in Togo, with a multi-skilled anesthetic team.


Aim: To describe the anesthetic management and morbidity of thoracic surgery.


Methods: A descriptive, prospective and observational study was conducted on a cohort of patients who underwent a thoracic surgery between June 1 and August 31, 2022, at the national referral hospital in Lomé. The study examined pre-anesthetic assessment, surgical, anesthetic, and postoperative data.


Results: Twenty-five patients with a mean age of 40 ±13 years were included. The surgery was elective in 69% of cases. The anesthetic assessment showed anemia (64%) and a reduced forced expiratory volume in one second (60%)


All patients were operated on under general anesthesia with controlled ventilation, including 64% of one-lung ventilation. Surgical procedures included pleural decortication (28%), pericardial drainage (16%), pneumonectomy (16%), and pulmonary lobectomy (12%).  Twenty-three patients (92%) experienced intraoperative complications, including arterial hypotension (80%), shock (56%), and hypoxia (24%).


Multimodal analgesia including paracetamol (100%), nefopam (92%), morphine (76%), paravertebral analgesia (20%), and thoracic epidural analgesia (8%), was used postoperatively.


Seventeen patients (68%) experienced postoperative complications, including anemia (20%), pneumonia (12%), and parietal infection (12%). Three patients (12%) died.


Conclusion: General anesthesia with, one-lung ventilation in most cases, was the anesthetic technique in thoracic surgery. Complications, mainly cardiovascular, occurred intraoperatively, with high postoperative mortality.

Keywords:

Thoracic surgery, pneumonectomy, anesthesia, One-lung ventilation, multimodal analgesia, morbidity, Togo, Africa

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