Laparoscopic cholecystectomy has been considered the "gold standard" for the surgical treatment of symptomatic gallstone disease because it numerous advantages. However, this surgical technique presents specific anesthetic challenges. The aim of study was to describe the anesthetic management of laparoscopic cholecystectomies at the Brazzaville University Teaching Hospital (BUTH). This was a retrospective, cross-sectional study conducted from January 1, 2023 to April 30, 2025, at BUTH. All patients aged 15 years and older who underwent laparoscopic cholecystectomy were included. The epidemiological, anesthetic, surgical variables and outcomes were analyzed using Excel 2016 software. Fifty-eight patients underwent laparoscopic cholecystectomy. The mean age was 34.1 ± 14.3 years (range: 15 – 72 years). The sex ratio was 0.3. Symptomatic gallstones (96.5%) were the main indication for surgery. Comorbidities were present in 63.8% of cases, including homozygous sickle cell disease in 72.9%. Symptomatic gallstone disease (96.5%) was the primary indication for surgery. Difficult intubation, as predicted by the Mallampati score, was reported in 8.6%. Patients were classified as ASA 2 (67.2%). An Apfel score ≥ 2 was reported in 45 patients (77.6%). Antibiotics were administered to 89.6% of patients and domined by cefuroxime. All patients underwent surgery under general anesthesia with orotracheal intubation. Capnography was monitored in five patients (8.6%). Hypotension (27.58%) and severe bradycardia (8.62%) were the observed anesthetic complications. Four patients (6.9%) required conversion to laparotomy. The mean duration of abdominal insufflation was 79.9 ± 47.0 minutes and the mean duration of anesthesia was 145.5 ± 53.0 minutes. Postoperative complications were present in four patients with sickle cell disease (6.9%): one bone vaso-occlusive crisis, two respiratory infections and one pneumothorax associated with subcutaneous emphysema, requiring admission to the intensive care unit with an unfavorable outcome. Conclusion: Anesthesia for laparoscopic cholecystectomy is feasible at the BUTH for symptomatic gallstones, even in patients with sickle cell disease. Improved intraoperative monitoring could reduce the risk of postoperative complications.
Objective: Although international guidelines outline best practices for assessing and delivering nutrition to critically ill patients, their implementation varies considerably across Intensive Care Units (ICUs). This study aimed to evaluate current nutritional practices among intensivists, identify challenges in meeting nutritional goals in the ICU, and describe strategies used for post-ICU nutritional care. Methods: An online survey was disseminated to certified intensivists, who were invited to complete a structured questionnaire electronically. Institutional ethics approval (INT/ECI2023/P2/1344) and clinical trial registration (CTRI/2024/01/061457) were obtained. Results: Of 201 respondents, 53% had more than 10 years of clinical experience, and 33% performed in-hospital ICU duties. Most institutions provided patient nutrition 79% reported awareness of established nutritional protocols, yet 69% cited the unavailability of qualified ICU dietitians. Only 6% used indirect calorimetry for caloric assessment. Enteral nutrition was initiated in 95% of patients, predominantly via intermittent bolus feeding (70%), and 80% commenced feeding soon after ICU admission when feasible. Feed intolerance was assessed in 87% of cases using gastric residual volumes, with a threshold of greater than 50% of the previous feed being the common criterion. Nearly 60% initiated parenteral nutrition within 48–72 hours of developing enteral feed intolerance. Protein or albumin levels were used by 69% to assess nutritional status. Only 7% reported structured post-ICU nutritional follow-up. Conclusions: Substantial variability exists in ICU nutritional practices, with limited adherence to international recommendations and significant resource-related barriers.
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is acommon and serious complication occurring within 7 days after cardiac surgery. Withover 2 million cardiac surgeries performed worldwide annually, CSA-AKI incidenceranges from 19% to 43% in adults and up to 64% in neonates, increasing perioperativemortality by 3-8-fold, prolonging hospital stays, and substantially increasinghealthcare costs. Despite advances in perioperative care, CSA-AKI remains a majorclinical challenge due to its multifactorial pathophysiology and limited therapeutic options. Purpose: This review aims to provide a comprehensive and updated overview of CSA-AKI, systematically summarizing current knowledge on its pathophysiology, risk factors, diagnostic criteria, prevention strategies, and treatment options, with particular emphasis on recent advances through 2026. Methods: A comprehensive literature review was conducted by searching electronic databases for relevant clinical studies, systematic reviews, meta-analyses, and guideline updates on CSA-AKI published through 2026. The reviewed literature was analyzed and synthesized across key domains including pathophysiological mechanisms, risk factor classification, diagnostic criteria comparison, and evidence-based prevention and treatment strategies. Conclusions: The pathophysiology of CSA-AKI involves multipleinteracting mechanisms including hypoperfusion, ischemia-reperfusion injury, inflammation, oxidative stress, nephrotoxicity, and genetic susceptibility, with renalhypoperfusion during cardiopulmonary bypass identified as a central mechanism. KDIGO criteria currently offer the highest diagnostic sensitivity among availableclassification systems. Goal-directed perfusion (GDP) strategies maintaining indexedoxygen delivery above targeted thresholds have demonstrated significant reduction in CSA-AKI incidence, with emerging evidence supporting sex-specific optimization. Pharmacological advances, particularly amino acid therapy, have shown a 28%reduction in CSA-AKI incidence with a Class IIa recommendation. Earlyidentification of high-risk patients, optimization of cardiopulmonary bypassmanagement through GDP, and implementation of evidence-based prevention bundlesremain the cornerstones of clinical management. Future research should prioritizetargeted pharmacological therapies, machine learning-based risk prediction models, and adequately powered multicenter trials.
Erector spinae plane blocks are increasingly incorporated into thoracic surgical analgesia practices, yet evidence regarding its effect on postoperative opioid requirements following video-assisted thoracoscopic surgery remains mixed. The objective of this study was to evaluate whether erector spinae plane blocks reduce postoperative opioid consumption without differences in patient-reported pain scores in patients undergoing video-assisted thoracoscopic surgery. We conducted a retrospective single-center cohort study at a tertiary academic hospital including adult patients who underwent video-assisted thoracoscopic surgery between October 2021 and October 2024. Procedures included lobectomy, wedge resection, and other pulmonary or pleural operations; patients with chronic pain, opioid dependence, conversion to thoracotomy, or incomplete data were excluded. Erector spinae plane blocks were performed at the discretion of the attending anesthesiologist using bupivacaine or ropivacaine, and all patients received multimodal analgesia with postoperative patient-controlled analgesia. Primary outcomes were patient-controlled analgesia morphine milligram equivalents and total postoperative morphine milligram equivalents. Secondary outcomes included pain scores at 0, 12, and 24 hours, adjunct analgesic use, and hospital and post-anesthesia care unit length of stay. Among 418 patients, erector spinae plane blocks were associated with lower patient-controlled analgesia morphine milligram equivalents (17 vs 24, p < 0.001) and lower total postoperative morphine milligram equivalents (33 vs 43, p < 0.001), without differences in pain scores, adjunct analgesic use, or length of stay. Multivariable linear regression confirmed independent reductions of 3.5 morphine milligram equivalents for patient-controlled analgesia use and 7.5 morphine milligram equivalents for total postoperative opioid consumption. Erector spinae plane blocks were associated with statistically significant reductions in postoperative opioid requirements without differences in patient-reported pain scores. The magnitude and clinical relevance of this reduction require further evaluation in prospective randomized trials.
Post-dural puncture headache (PDPH) is a common complication following spinal anaesthesia, characterised by a postural headache that worsens on standing and improves when supine, with an incidence ranging from 1% to 30% depending on patient and procedural factors. It results primarily from cerebrospinal fluid leakage at the dural puncture site, leading to decreased intracranial pressure, compensatory cerebral vasodilation, and traction on pain-sensitive structures. Despite preventive measures such as atraumatic needles and minimising puncture attempts, PDPH remains clinically significant, prompting interest in pharmacological strategies. Vitamin C, owing to its antioxidant, vasomodulatory, and collagen synthesis–enhancing properties, may support dural healing and regulate cerebral vascular tone, thereby reducing PDPH risk. This prospective, randomised, double-blind, placebo-controlled study evaluated the effect of perioperative vitamin C supplementation on PDPH in 120 ASA I–II patients (18–60 years) undergoing elective lower abdominal or lower limb surgeries under spinal anesthesia. Participants were allocated into two groups: Group V received oral vitamin C (1 g preoperatively and 1 g 12 hours postoperatively), while Group P received placebo. Spinal anesthesia was administered using a 25G Quincke needle with 0.5% hyperbaric bupivacaine. The primary outcome was PDPH incidence within five postoperative days, while secondary outcomes included severity (VAS), onset time, duration, safety, and hemodynamic stability. Baseline characteristics were comparable between groups. The incidence of PDPH was significantly lower in the vitamin C group (10%) compared to the placebo group (21.7%) (p = 0.04). Severity was also reduced (VAS 3.2 ± 1.0 vs 4.6 ± 1.2; p < 0.01), and duration was shorter (2.4 ± 0.8 vs 3.5 ± 1.1 days; p = 0.03). However, the time of onset showed no significant difference (30 ± 5 vs 28 ± 6 hours; p = 0.22). No adverse effects were observed. In conclusion, perioperative vitamin C supplementation significantly reduces the incidence, severity, and duration of PDPH without affecting onset time, offering a safe, cost-effective, and practical adjunct for improving postoperative outcomes and patient comfort following spinal anesthesia.
