Anesthesia for surgery for typhoid perforation in a rural African hospital

Abstract

Background : Typhoid perforation is a condition commonly seen in developing countries including those of sub-Saharan Africa. Anesthetic management for surgery in typhoid perforation poses great challenges to the anesthetist practicing in Africa, especially in the face of limited resources. Materials and Methods : The anesthetic management of patients who underwent surgery for typhoid perforation at the SIM Hospital in Galmi, Niger Republic, between December 2004 and December 2005, was retrospectively reviewed. Results : There were 56 patients who had surgery for typhoid perforation during the period. Forty-one were males while 15 were females with a male:female ratio of 2.7:1. Their age ranged between 3 and 62 years with a mean of 23 years. Of these, 19 (33.9%) were children aged 15 years and below. Twenty-eight of the patients (i.e. 50%) were assessed as American Society of Anesthesiologists (ASA) physical status class IV, while 22 (39%) were ASA III and 6 (11%) were ASA V. Thirty surgeries (i.e. 53.6%) were done under spinal anesthesia, 9 (16%) under general inhalational anesthesia using halothane, 11 (19.6%) under ketamine anesthesia and 6 (10.7%) had drainage of intra-abdominal abscesses under local anesthesia. The overall mortality rate was 26.8%. The mortality rates following the different techniques of anesthesia were: spinal anesthesia 20%, general inhalational anesthesia 22%, ketamine anesthesia 18% and local anesthesia 83.3%. ASA III patients had a mortality rate of 9%, while the mortality rate was 28.6% in ASA IV patients and 83.3% in ASA V patients. Mortality was significantly related to the ASA status of the patient, while there was no correlation between mortality and anesthetic technique used. Conclusion: Proper preoperative resuscitation and a well-conducted anesthesia, using a technique that the anesthetist is well conversant with, appear to be the key to successful anesthesia in patients with typhoid perforation. Anesthetists practicing in rural Africa should be encouraged to acquire skill in the art of spinal anesthesia since it is cheap, easy to administer and can be safely utilized in these patients.