Background: Despite advances in anesthesia, the risk of complications in pediatric anesthesia remains a major concern. The objective of this study was to identify factors associated with perianesthetic complications in this specialty. Methods: This was a retrospective cohort study from June 1 to December 31, 2024, conducted in four hospitals in Kinshasa, which included children from birth to 15 years of age undergoing anesthesia for emergency or scheduled surgical or diagnostic procedures in compliance with ethical rules. Data were analyzed using the R 4.4.2 programming language (R Foundation for Statistical Computing, Austria) for p < 0.05. Results: 394 children were registered. They were male (57%, sex ratio 1.3), with a mean age of 4.5 ± 4.6 years (from 2 days to 15 years), mostly infants (33.5%) and classified ASA I (60%). Anesthesia conducted by a senior (89%) was general (82.7%) with tracheal intubation (76%), for a scheduled intervention (60%) performed by a senior surgeon (87%) with the predominance of digestive (47%), orthopedic (13%) and urological (10%) surgery. Complications occurred in 28.4%, in per-anesthetic (25.4%) mainly respiratory (14.5%), and in post-operative (16%) often cardiorespiratory cardiac arrest (5.8%) and desaturation (5.6%). Mortality was 7.1% at 3 days and 10.4% at 30 days. ASA score ≥ 3, urgent nature of the intervention, prolonged duration of surgery and reinterventions were major risk factors for morbidity and mortality. Conclusion: Compared to previous years, the practice of pediatric anesthesia in our country is improving both in terms of personnel and anesthetic products, with a reduction in the frequency of complications. It seems imperative to optimize the condition of patients and improve intraoperative monitoring for even safer anesthesia. And promote the construction of pediatric hospitals with critical care or resuscitation units and adapted operating theaters, equipped with advanced monitoring equipment for better care of children.
References
[1]
Coté, C.J., Lerman, J. and Anderson, B.J. (2018) A Practical Guide to Anesthesia for Infants and Children. 6th Edition, Elsevier, 1256 p.
[2]
Tsang, M. (2018) A Practice of Anesthesia for Infants and Children, Sixth Edition. CanadianJournalofAnesthesia, 65, 1392-1393. https://doi.org/10.1007/s12630-018-1201-4
[3]
Ogondon, B., et al. (2014) Practice of Pediatric Anesthesia in Emergency at the Cocody University Hospital (Abidjan-RCI). Rev. Afr Anesthesia Medicine Emergency, 19, 6-9.
[4]
Paterson, N. and Waterhouse, P. (2010) Risk in Pediatric Anesthesia. PediatricAnesthesia, 21, 848-857. https://doi.org/10.1111/j.1460-9592.2010.03366.x
[5]
Trotman, G., Foley, C.E., Taylor, J., DeSale, S. and Gomez-Lobo, V. (2017) Postoperative Outcomes among Pediatric and Adolescent Patients Undergoing Minilaparotomy vs Laparoscopy in the Management of Adnexal Lesions. JournalofPediatricandAdolescentGynecology, 30, 632-635. https://doi.org/10.1016/j.jpag.2017.06.009
[6]
Michel, F. (2018) Indicateurs de complications postopératoires en anesthésie pédiatrique. Anesthésie&Réanimation, 4, 345-353. https://doi.org/10.1016/j.anrea.2018.04.001
[7]
Habre, W., Disma, N., Virag, K., Becke, K., Hansen, T.G., Jöhr, M., et al. (2017) Incidence of Severe Critical Events in Paediatric Anaesthesia (APRICOT): A Prospective Multicentre Observational Study in 261 Hospitals in Europe. TheLancetRespiratoryMedicine, 5, 412-425. https://doi.org/10.1016/s2213-2600(17)30116-9
[8]
Brouh, Y. (2013) Pediatric Anesthesia in French-Speaking Black Africa: What Practice? Ramur, 18, 1-2.
[9]
Torborg, A., Cronje, L., Thomas, J., Meyer, H., Bhettay, A., Diedericks, J., et al. (2019) South African Paediatric Surgical Outcomes Study: A 14-Day Prospective, Observational Cohort Study of Paediatric Surgical Patients. BritishJournalofAnaesthesia, 122, 224-232. https://doi.org/10.1016/j.bja.2018.11.015
[10]
Wood, G., Barayan, G., Sanchez, D.C.J., Inoue, G.N.C., Buchalla, C.A.O., Rossini, G.A., et al. (2013) Validation of the Pediatric Surgical Risk Assessment Scoring System. JournalofPediatricSurgery, 48, 2017-2021. https://doi.org/10.1016/j.jpedsurg.2013.04.017
[11]
Mouzou, T., Egbohou, P., Tomta, K., Sama, H., Assenouwe, S., Akala, Y., Assih, P. and Randolph, L. (2016) Pediatric Anesthesia Practice in a Developing Country: Experience of Sylvanus University Hospital Olympio of Lomé in Togo. Ramur, 21, 38-43.
[12]
Newton, M.W., Hurt, S.E., McEvoy, M.D., Shi, Y., Shotwell, M.S., Kamau, J., et al. (2020) Pediatric Perioperative Mortality in Kenya: A Prospective Cohort Study Conducted in 24 Hospitals. Anesthesiology, 132, 452-460. https://doi.org/10.1097/aln.0000000000003070
[13]
Amengle, A.L., Bengono Bengono, R., Metogo Mbengono, J.A., Zambo, A., Esiene, A. and ZeMinkande, J. (2020) Peri-and Postoperative Complications in Pediatric Anesthesia in 2 Reference Hospitals in Cameroon. Ramur, 25, 16-21. https://www.web-saraf.net/Complications-per-et.html
[14]
Mulapu, N., Mbala, R., Bula-Bula, M., Ilunga, M., Mbombo, W. and Kilembe, M. (2012) Complications of Awakening in Pediatric Anesthesia: Case of the University Clinics of Kinshasa and the Pediatric Hospital of Kalembe-Lembe. Ramur, 17, 14. https://web-saraf.net/IMG/pdf/saranf_2012_-_an.pdf
[15]
Umba, D.M. (2023) Pratique de l’anesthésie pédiatrique dans la Ville de Lubumbashi en RD Congo: Indications, Complications et Facteurs de mortalité. AmericanJournalofMedicalandClinicalResearch&Reviews, 2, 1-12. https://doi.org/10.58372/2835-6276.1055
[16]
Joseph, A., Serge, M., Ernest, A., Yasmine, L., Eugène, Z., Séraphin Antoine, G., et al. (2021) Practice of Pediatric Anesthesia in Sub-Saharan Africa: Experience of Two Referral Hospitals in Benin. AmericanJournalofPediatrics, 7, Article No. 219. https://doi.org/10.11648/j.ajp.20210704.17
[17]
Niandou, M., et al. (2015) Pediatric Anesthesia Practice at the Lamordé National Hospital in Niamey. Rev. Afr Anesthesiology Med Urgence (Special Congress), 20, 1-134.
[18]
Samaké, B., Keita, M., Magalie, I. and Diallo, G. (2010) Adverse Events of Anesthesia in Scheduled Pediatric Surgery at Gabriel Touré Hospital. Mali Medical, 25, 1-5.
[19]
Talabi, A.O., Ojo, O.O., Aaron, O.I., Sowande, O.A., Faponle, F.A. and Adejuyigbe, O. (2021) Perioperative Mortality in Children in a Tertiary Teaching Hospital in Nigeria: A Prospective Study. WorldJournalofPediatricSurgery, 4, e000237. https://doi.org/10.1136/wjps-2020-000237
[20]
Nze Obiang, P.C., Obame, E.R., Edjo Nkilly, G., et al. (2023) Analysis of the Practice of Pediatric Anesthesia at the Mother and Child University Hospital of Libreville. Health Sciences and Diseases, 24, 161-165.
[21]
Disma, N., Veyckemans, F., Virag, K., Hansen, T.G., Becke, K., et al. (2021) Morbidity and Mortality after Early-Life Anesthesia: Results from the European Multicenter Prospective Observational Study, Audit of Anesthesia Practices in Newborns and Children in Europe (Nectarine). British Journal of Anaesthesia, 126, 1157-1172. http://creativecommons.org/licenses/by-nc-nd/4.0/
[22]
Graaf, J.C., Sarfo, M.C., Wolfswinkel, L.V., et al. (2016) Critical Incidents Related to Anesthesia in the Perioperative Period in Children; Proposal for a System for Reporting Critical Incidents Related to Anesthesia in Children. Pediatric Anesthesia, 26, 7-43.
