Introduction: The use of adjuvants in general anesthesia (GA) is experiencing renewed interest in digestive surgery [1,2]. Objective: To provide proof of the efficacy of Ketamine and Lidocaine in the morphine saving strategy in digestive surgery. Materials and Methods: This was a randomized, single-blind, controlled trial. The study took place over a period of 6 months, from July to December 2020 at the Essos hospital center. Patients over 18 years of age scheduled for digestive surgery were divided into 3 groups: Ketamine (GK), Lidocaine (GL), control (GT). At induction of anesthetic, the GK group received IV ketamine as a bolus dose of 0.5 mg / kg; then 0.125 mg / kg / h continuously intravenously with an electric syringe pump (IVSE). The GL group received Lidocaine as an IV bolus of 1.5 mg / kg at induction anesthetic, followed by 1 mg / kg / h IVSE. The GT group did not receive any adjuvant administration. Intra and postoperative opioid consumption, intensity of postoperative pain, area of peri-scarring hyperalgesia and incidence of postoperative nausea and vomiting (PONV) were listed. A probability P <0.05 was used as the significance level. Results: During the survey period 60 participants met the inclusion criteria: 27 for the GK group, 15 for the GL group and 18 for the GT group. The average age of the participants was 55 with extremes ranging from 18 to 65. The sex ratio was 2.5 in favor of men. The majority of the workforce was in the ASA 2 class (57.1%). The main indications for surgery were hemicolectomy (33.3%), bilio-digestive bypass (19%) and cholecystectomy (14.8%). Ketamine and Lidocaine reduced intraoperative fentanyl consumption by 67.7% and 42.85%, respectively (P <0.001). The postoperative morphine savings were remarkable with Ketamine and Lidocaine in the order of 14.8mg and 20mg respectively (P = 0.001). The numerical scale was significantly improved with Ketamine and Lidocaine in the first 24 hours postoperatively (P = 0.001). The area of pericicatricial hyperalgesia was limited to the operative site for all participants in the GK and GL groups (P <0.001). The incidence of PONV was reduced in the test groups in a comparable manner (p = 0.045). Conclusion: The use of ketamine and IV lidocaine in the morphine sparing strategy in digestive surgery has been shown to be effective. The benefit / risk balance argues in favor of the use of these molecules in countries with low per capita income.

Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.