juin 2014, par Sama HD , Tomta K , Mouzou T , Egbohou P , Turc R , Walker IA

Background : The aim of the Lifebox Foundation (www.lifebox.org) is to improve safety in surgery and anesthesia on a global scale by delivering an essential piece of monitoring equipment for anaesthesia safety and a training programme. The equipment and training was distributed to 100 anesthesia providers in Togo in November 2012.1 This prospective and descriptive survey describes the incidence of hypoxia and other related events detected using the Lifebox oximeter in a cohort of patients undergoing surgery in the maternity unit from 1st January to 31 March 2014.
Patients and Method : All mothers in labour who received anaesthesia in the maternity unit were included. Audit data collection form we completed included : ASA score, anaesthesia technique, lowest saturation recorded during the case, intervention undertaken to correct hypoxia, maternal and neonatal outcomes.
Results : total number of 21 cases was recorded on 540 anaesthesia procedures performed. It was 26% (140) planned interventions and 74% (440) emergencies. 20% of anaesthesia procedures received general anaesthesia and 80% received regional anaesthesia, with spinal anaesthesia and epidural analgesia accounting for 85.7% and 14.3% respectively. Each anaesthesia provider had their own Lifebox pulse oximeter, and there were a total of 15 oximeters within the maternity unit. Capnography equipment was not available. The pulse oximeter helped to detect : hypoxia (14) ; hypoventilation and related complications. 5 deaths were related to anaesthesia (see table 1). All anaesthesia providers said that the pulse oximeter was essential for safe anaesthesia care ; no one reported a problem with using the pulse oximeter.

Table I : causes of maternal deaths and their absolute numbers

Causes of maternal deaths Absolute numbers
Hemorrhage 2
Eclampsia 2
Sepsis 1
Embolism 1
Anesthesia 5
Cardiopulmonary arrest 2
Aspiration and edema 2
Pneumonia. Post anoxic coma 1
Total 11

Conclusion : our survey shows that pulse oximetry provides effective early detection of hypoxia in patients undergoing surgery in the maternity services in Togo. This allows for early intervention of ventilation mishaps, before damaging hypoxemia occurs. It also allows early detection of operative cardiac arrest, with successful outcomes seen in 2 of 3 patients.
Key words : pulse oximeter, hypoxia, anaesthesia, death, Lifebox, Togo

http://blogs.bmj.com/bmj/2012/12/18/lifebox-q-and-a-togo-facing-the-facts-and-making-a-difference/

La vie de l'Anesthésie