Broken needle during spinal anesthesia: an avoidable complication

The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication.

Head Computed Tomography Scan in Isolated Traumatic Brain Injury in a Low-Income Country

BACKGROUND

Head computed tomography scan (HCTS) is the cornerstone of the management of traumatic brain injury (TBI). The impact of performing a HCTS in TBI has been scarcely investigated in low-income countries (LICs). Furthermore, the cost of a HCTS is a burden for family finances.

METHODS

A prospective observational study was conducted in Burkina Faso. All consecutive patients with isolated TBI needing a HCTS were included. Result and impact of HCTS were evaluated.

RESULTS

There were 183 patients prescribed a HCTS for an isolated TBI. Mild, moderate, and severe TBIs represented 55%, 31%, and 14% of the cases, respectively. In 72 patients, HCTS was not performed because of economic barrier. Among the 110 HCTSs performed, there were intracranial lesions in 81 (74%) patients. Among the 110 performed HCTS, 34 (31% [22.3%-39.5%]) HCTSs altered the management of TBI, with 16 (15%) cases of surgical indications, and 20 (18%) cases of modification of the medical treatment. In patients without neurologic signs, the rate of alteration of management was 28%. The realization of the HCTSs was associated with the presence of neurologic signs and income level. In-hospital mortality was 11% (n = 21). Among the 162 patients discharged alive from the hospital, 27 (20%) were discharged with a severe disability state (Glasgow Outcome Scale score ≤3). The rate of return to work was 77%.

CONCLUSIONS

No modification of guidelines can be advocated from this study. However, given the financial burden on family of performing HCTS, research may identify criteria allowing for avoiding HCTS. Guidelines specific to LICs are needed to get closer to the best interest of patients.

Hernie diaphragmatique post-traumatique de l’enfant: à propos d’un cas au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle de Ouagadougou

La hernie diaphragmatique post-traumatique est une urgence chirurgicale rare chez l’enfant mais pouvant mettre rapidement en jeu le pronostic vital. Les auteurs rapportent le cas d’un garçon de 04 ans admis aux urgences pour douleur abdominale suite à une contusion thoraco-abdominale par accident de la voie publique. Le bilan radiologique initial a consisté en une échographie abdominale qui a révélé un hémopéritoine de petite abondance sans lésion focale. Douze heures après son admission, le patient a présenté une détresse respiratoire avec tableau clinique de pneumothorax gauche qui a nécessité une exsufflation en urgence. Le diagnostic de hernie diaphragmatique gauche a été posé à la radiographie du thorax réalisée après la ponction. L’enfant a bénéficié d’une cure chirurgicale. L’évolution a été favorable. La hernie diaphragmatique post traumatique, bien que rare chez l’enfant, devrait être systématiquement recherchée par une radiographie thoracique ou un scanner thoraco-abdominal devant tout traumatisme abdominal avec hyper pression. Son traitement est chirurgical.