ABSTRACT
Background: Conjoined twins (CTs) are rare and Anesthesia may be required for diagnostic imaging, invasive procedures and/or separation. This article described the anesthetics for CTs’ separation performed locally in West Africa from 2016 to 2022. Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. Methods: Anesthetic management for the separation of conjoined twins performed from 2016 to 2022 in five West Africa countries, Benin, Burkina Faso, Guinea, Niger and Senegal, are reported on. The data collection was done retrospectively. Each country was sent their data to Burkina Faso for study. The parental consents were obtained for surgery and publication. Results: During the period, nine conjoined were reported. The cases were: 5 omphalopagus, 2 pygopagus, 1 xipho-omphalopagus and 1 thoraco-omphalopagus. Inhalation anesthesia or propofol combined with IV opioids were used. Monitoring relied heavily on pulse-oximetry. Manual ventilation was used in five separations. Separations were achieved in 1.5-4 hours. The death of a twin triggered surgery in one pair and three other babies died after the surgery. The fourteen remaining babies developed well. Peri-operative difficulties revealed widespread difficulties in Africa. Conclusion: CT separation surgery still constitutes an extraordinary challenge in low and middle income countries, but well-trained anesthesiologists, a multidisciplinary approach and international contacts can lead to safe performance of complex neonatal surgeries.

ABSTRACT
Background: Post-dural puncture headache (PDPH) is a complication of dura mater puncture. In order to reduce the burden and related morbidity, postpartum women who suffer from PDPH must be identified and treated as soon as possible utilizing highly effective, noninvasive approaches that are simple to apply in settings with limited resources. Objective: The aim of this study is to assess the causes, effects & management of post dural puncture headache among obstetric patients in a tertiary care hospital. Methods: The cross-sectional observational study was conducted in the department of Surgery, North Bengal Medical College Hospital, Sirajgonj, Bangladesh, from October 2022 to September 2023. A total of 300 patients were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, most of the 104 (34.7%) patients were within the age group of 31 - 35 years. The mean±SD age of the patients was 32.6±1.3 years. BMI of most of the patients 137 (45.7%) were in the normal range (18.5 to <24.9), 103 (34.3%) had overweight (25-29.9), 37 (12.3%) were obese (≥30.0) and 23 (7.7%) had underweight (<18.5). Most of the patients 133 (44.3%) were multipara, among 300 patients 214 (71.3%) patients gestational age was >37 weeks and 86 (28.7%) patients gestational age was<37 weeks. About 49 (16.3%) had preexisting/ pregnancy-related medical conditions and emergency surgery was done in 217 (72.3%) patients. The majority of the participants 251 (83.7%) had only one attempt at the puncture, and all 300 (100.0%) were in a sitting position during the procedure, and a 25G-sized spinal needle was used in 296 (98.7%) of the patients. Most participants reported cerebrospinal fluid loss as minimal. Majority of the 231 (77.0%) patients had previous history of PDPH. All 300 (100.0%) ..

ABSTRACT
Diabetic ketoacidosis is a real public health problem in our context with an incidence of 12.67%. Diabetic ketoacidosis is a therapeutic emergency that requires rigorous management, especially in the acute phase, while respecting the therapeutic particularities of each patient and taking care to detect the etiologies. The etiological research of ketoacidotic decompensation has enabled us to determine, as the main triggering factors, therapeutic non-compliance and then infections, predominated by urinary infections and pneumonia. Initial treatment is based on rehydration, insulin therapy and correction of electrolyte and acid-base disorders, of course, with rigorous and essential monitoring combating possible complications, particularly iatrogenic, represented in our context mainly by the hypokalemia, hypoglycemia, cerebral edema and acute renal failure. The analytical statistical study allowed us to conclude that death was essentially linked to complications occurring during the hospital stay, notably septic shock, cerebral involvement, renal failure and the use of mechanical ventilation.

ABSTRACT
Colorectal cancer, by its frequency and severity, represents a serious public health problem worldwide. In Morocco, the incidence of colorectal cancer is constantly increasing. Post-operative morbidity and mortality is an event whose evaluation and analysis are necessary to improve surgical results and optimize patient care. Thus, knowledge of the causes and risk factors of morbidity and mortality will contribute not only to a better evaluation of patients candidates for colorectal surgery, but also to reveal new avenues of research to improve the post-operative prognosis of these patients. The objective of this retrospective work is to carry out an epidemiological study of the morbidity and mortality of patients admitted during the postoperative period of colorectal surgery to the surgical intensive care unit of the Ibn Rochd University Hospital in Casablanca; as well as the search for potential predictive factors associated with it.

ABSTRACT
Anemia is one of the most common pathologies in the world, with major consequences on health, it is a common condition among patients Surgical, and its prevalence varies between 11% and 76%, depending on sex, age and the underlying pathology requiring surgical intervention, as well as the Hb threshold used for its definition. Our study concluded that anemic patients account for 22.99%. The 38 to 47 age group seemed to be the most affected with a prevalence of 35.48%. The sex ratio is 1.17 in favor of men. Among surgical patients, trauma patients were most affected by anemia (46.51%). Mild hypochromic microcytic anemia is the most common type of anemia in surgical patients. Only 26% of patients received anti-anemia treatment. Curative and above all preventive therapeutic care is essential. Strongly to understand the consequences of this scourge.

ABSTRACT
Supraclavicular brachial plexus block is a common regional anesthesia technique used for upper extremity orthopedic surgeries. The addition of adjuvants to local anesthetics can prolong the duration of analgesia and improve the quality of the block. This prospective, randomized, double-blind study aimed to investigate the impact of dexamethasone on the efficacy of a lignocaine and ropivacaine mixture for ultrasound guided supraclavicular block. A total of 80 patients scheduled for major forearm orthopedic surgery were randomly assigned to receive either a mixture of lignocaine 2% and ropivacaine 0.5% (control group) Group A or the same local anesthetic mixture with the addition of dexamethasone 8 mg (dexamethasone group) Group B. The primary outcome was the duration of analgesia, defined as the time from block placement to the first request for rescue analgesia. Secondary outcomes included the onset time of sensory and motor block, the quality of the block, and the incidence of adverse events. The results showed that the addition of dexamethasone significantly prolonged the duration of analgesia compared to the local anesthetic mixture alone (135 ± 10 min vs. 170 ± 15 min, respectively, p < 0.001). Addition of dexamethasone to mixture of lidocaine and ropivacaine in supraclavicular block results in prolonged duration of sensory and motor block and also improves quality of analgesia without affecting its onset.

ABSTRACT
Background: Postoperative period is a time of significant physiological flux, patient recover from the acute derangements resulting from anaesthesia and surgery. On arrival at PACU, the patient is re-evaluated by the anaesthesia provider gives a handover to the responsible PAC provider. Incomplete handover increase risk of morbidity and mortality to patients. Objective: Study assessed the handover practice of postoperative patient from operating room to post-anaesthesia care unit in Muhimbili Orthopedic Institute operating theatre recovery room. Methodology: This was a hospital based cross-sectional observational study which was conducted at Muhimbili Orthopedic Institute Hospital located at Upanga. Handover conducted by Anaesthetic Provider to PACU nurse in the Recovery rooms were Observed and information communicated were marked using SBAR handover checklist. Then anaesthetic providers and PACU nurse were surveyed to know which item in the checklist was relevant to be communicated during handover. Data collected was analyzed using Statistical Package for Social Scientists (SPSS version 23). Results: 319 PACU handover were observed. 17.5% of the handover were completed and rated as Good, 50.8% were satisfactory and 31.7% poorly completed. Most communicated items were Vital Sign 90.6%, Operation Underwent 86.8% and Type of anaesthesia 85.9% and the least was ASA 24.5%. Items providers thought should be communicated were Name of the patient (0.954), Age and Gender (0.938), Type of Anaesthesia (0.925). Among the Anaesthetic Provider Cadre Physician Providers provided Good and Satisfactory handover compared to Nurse Provider. Conclusion: Majority of the handover were satisfactorily completed, with Vital Sign, type of anaesthesia and Operation underwent being the most communicated items in checklist.