Objective: Describe the perioperative management of peritonitis in surgical emergencies.
Methodology: This was a prospective observational study of the descriptive type over a period of 12 months from January 01 to December 31, 2020 in the surgical emergency room at the CHU Ignace Deen. Included in the study were all patients admitted for peritonitis aged greater than or equal to 18 years. The parameters were epidemiological, clinical and anesthetic.
Results: Of the 653 admissions to surgical emergencies in 2020, 185 cases presented with peritonitis,
i.e. 29.3%. The average age was 38.6 ± 16.64 years with extremes of 18 and 90 years. The sex ratio was 1.89. The comorbidities were dominated by gastritis and hypertension,
i.e. 22%. The patients were classified as ASA 3U (52.4%), ASA2 U (39.5%) and ASA 4 U (8.1%). Preoperative resuscitation was provided only with 100% saline. 25.5% of patients had received a blood transfusion. The response time was less than 48 hours,
i.e. 77.6%. General anesthesia was performed for all patients. Ketamine was the most used IV hypnotic (56.3%) combined with 100% halothane. The curares used were suxamethonium at (81.6%), Atracurium (81.6%) and rocuronium at (18.3%). Fentanyl was the only morphine used. Senior anesthesia technicians provided anesthesia in (63.2%). Intraoperative incidents were dominated by hypotension, difficult intubation, cardiac arrest, respectively 10.3%, 8% and 0.5%. The immediate postoperative incidents were arterial hypotension, nausea and desaturation, respectively 52.9%, 80% and 32.4%. Mortality was 3.4%.
Conclusion: The perioperative management of peritonitis in the emergency room must be as early as possible in order to reduce morbidity and mortality.
Peritonitis, inflammation mainly of infectious origin of the peritoneum, remains one of the most frequent digestive emergencies and one of the leading causes of septic shock (behind pneumonia) [1] . Despite the progress made in their treatment, their morbidity and mortality remain high [2] . In addition, care has become more complex in recent years, due to the aging of the population, the appearance of multi-resistant bacteria (BMR), including in the community [3] . The anesthetic management of peritonitis is one of the pillars of his therapy. It cannot be dissociated from surgery, which remains the only alternative for its management. Peritonitis is one of the digestive surgical emergencies requiring rapid treatment. This makes anesthetic management more complex [4] . Peritonitis occupies a significant place among acute abdominal emergencies in our current practice, the morbidity and mortality linked to this condition, which is not only frequent in addition, involves the vital prognosis by multi-visceral failure. The objective of this study was to write the anesthesiological management of peritonitis in the emergency room of the CHU Ignace Deen.
2. Material and Methods
This was a prospective observational, monocentric and descriptive study lasting 12 months from January 1 to December 31, 2020. All patients admitted to surgical emergencies for peritonitis were included. We conducted an exhaustive recruitment of all patients meeting the inclusion criteria. The parameters studied were epidemiological, sociodemographic (age, sex, origin, profession), clinical, paraclinical (complete: blood count, blood ionogram, urea, creatinine, blood grouping, prothrombin time, activated or incomplete partial thromboplastin time: rate of haemoglobin, hematocrit level, blood grouping, bleeding time, coagulation time), imaging and anesthetic (pre, per and postoperative) and evolution, the qualification of the various anesthesia providers. The statistical analysis was exclusively descriptive. The results were expressed in absolute value and in percentage. Data collection was confidential and anonymity respected.
3. Results
In 2020, 653 patients were admitted to surgical emergencies for suspected surgical abdomen, we collected 185 cases of peritonitis, i.e. 28.3%. Men represented 65.4% of the workforce with a sex ratio of 1.89 (M/F). The average age was 18 and 90 years old. The age groups represented were: 21 to 40 years (51.4%), 41 to 60 years (26.5%) and greater than or equal to 61 years (12.4%). The patients were dominated by traders and those without professions in 26.5% and 25.4% respectively. The origin was rural 56.8% (Table 1). Comorbidities were dominated by arterial hypertension and gastritis (22%) respectively. On admission the clinical picture was dominated by an occlusive syndrome (abdominal pain, vomiting, cessation of transit and abdominal distension) at 100%, fever (100%), altered consciousness (52.4%), dehydration (94.6%), Oligo anuria was found in (47.6%),
Sociodemographic characteristics of patients
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