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.

Epilepsy is a chronic disease of the brain that affects all segments of the population around the world. It is characterized by recurrent seizures manifested by brief episodes of involuntary tremors affecting one part of the body or the whole body. These seizures are the result of excessive electrical discharges from a neuronal population. According to the World Health Organization, 50 million people are currently living with epilepsy worldwide. Almost 80 % of people with epilepsy live in low-income countries The management of this pathology remains difficult in sub-Saharan Africa for various reasons Sports activities, including swimming, are said to be beneficial in children and adolescents with epilepsy. But the practice of these activities is not without vital risk, it must be regulated accordingto the socio-economic, cultural and medical environment We report here a case of drowning in a 10-year-old adolescent girl, epileptic since earlychildhood and who takes depakine as a background treatment She was drowned while  swimming in a private pool, following an epileptic seizure. The interest of this presentation is tounderline the need to formulate recommendations adapted to sub-Saharan Africa concerning the practice of certain sports activities, such as swimming in a private pool for adolescents with epilepsy. The second objective is to highlight the importance of the chain of survival in the event of drowning, as a guarantee of the vital prognosis. L’épilepsie est une affection chronique du cerveau qui touche toutes les tranches de la population dans le monde Selon l’organisation mondiale de la santé, 50 millions de personnes vivent actuellement avec l’épilepsie dans le monde, près de 80% de personnes souffrant d’épilepsie vivent dans les pays à revenu faible. Sa prise en charge demeure laborieuse en Afrique subsaharienne (ASS). Les activités sportives, parmi lesquelles la natation, seraient  bénéfiques chez les adolescents épileptiques. Mais la pratique de ces activités n’est pas dénuée de risque vital, elle doit être régulée en fonction du contexte socio-economique, culturel et de l’environnement médical. Nous rapportons un cas de noyade chez une adolescente, épileptique depuis la tendre enfance et qui prend la dépakine en traitement de fond Elle a été victime de noyade en piscine privée, à la suite d’une crise d’épilepsie L’intérêt de cette présentation est de souligner la nécessité de formuler des recommandations adaptées à l’ASS au sujet de la pratique de certaines activités sportives à risque, comme la natation en piscine privée pour les adolescents épileptiques Le second objectif est de relever l’importance de la chaine de survie en cas de noyade, comme gage du pronostic vital.