Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication.

Au rédacteur en chef, La fondation Lifebox, la Société d'anesthésieréanimation et de médecine d'urgence du Burkina, la « World Federation of Societies of Anaesthesiologists » et la « Canadian Anaesthesiologists' Society International Education Foundation » avaient mis en oeuvre en 2013 le projet Lifebox au Burkina Faso. Ce projet avait permis la formation de 118 agents anesthésistes sur la pratique de l'oxymétrie pulsée et la check-list de l'Organisation Mondiale de la Santé (OMS) pour la sécurité du patient au bloc opératoire, ainsi que la distribution de 136 oxymètres de pouls à 57 hôpitaux publics.Nous avons mené une étude pour évaluer l'impact de ce projet sur la pratique de l'oxymétrie pulsée et de la check-list une année après sa mise en oeuvre.Il s'est agi d'une étude descriptive dont la collecte des données a été réalisée par enquête téléphonique du 07 août au 11 septembre 2014 auprès de responsables anesthésistes des 57 hôpitaux bénéficiaires du projet Lifebox. Les données avaient été analysées grâce au logiciel EPI INFO dans sa version 3.5.1 (« Center for Disease Control and Prevention » en collaboration avec l'OMS, Atlanta, GA, USA) et le risque µ a été fixé à 5 %.Le taux de participation à l'étude était de 100 %. Deux (3 %) médecins anesthésiste-réanimateurs et 55 (97 %) infirmiers spécialistes en anesthésie-réanimation ont été interrogés. Avant le projet Lifebox, 95 oxymètres fonctionnels étaient disponibles pour 136 salles d'intervention. Vingt-huit (49 %) blocs opératoires avaient un oxymètre de pouls fonctionnel dans chaque salle d'opération. L'oxymétrie pulsée était pratiquée systématiquement dans 42 (73 %) hôpitaux au cours de l'anesthésie. Seuls 10 (17 %) hôpitaux avaient une salle de surveillance post interventionnelle (SSPI) fonctionnelle et pour tous ces SSPI, l'oxymètre utilisé pour la surveillance des patients provenait de la salle d'opération. La check-list de l'OMS était pratiquée dans 10 (17 %) hôpitaux.Après le projet Lifebox, l'oxymétrie pulsée était pratiquée systématiquement dans tous les hôpitaux au cours de l'anesthésie et elle était pratiquée pour la surveillance du réveil des patients dans 54 (94 %) Cette lettre est accompagnée d'un éditorial. Veuillez vous référer à : Can J Anesth 2018; 65 : ce numéro.

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).