Background

Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anesthesia and surgery in hospitals in Africa.

Methods

This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407.

Findings

We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).

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Background: Enlargement of inferior nasal turbinates is a common cause of nasal obstruction. There are many surgical methods used to treat hypertrophied inferior turbinates such as electrocautery, partial turbinectomy, microdebrider reduction and radiofrequency thermal ablation (RFTA). The mucosal condition after surgery is an important factor that should be considered in evaluation of different techniques. Objective: This study aimed to examine the microstructural appearance of the ciliated epithelial tissues of inferior turbinates by light microscope. It was done by cytological examination of inferior turbinate mucosa in patients treated by radiofrequency thermal ablation (RFTA) and bipolar electro cautery (BEC) for hypertrophied inferior turbinates. Methods: A prospective study performed on 36 patients with hypertrophied inferior turbinates causing nasal obstruction. Patients were divided into two groups: group (A) were managed with radiofrequency thermal ablation (RFTA) and group (B) were managed with bipolar electro cautery (BEC). Cytological examination of nasal mucosa was done 3 months postoperatively. Results: by cytological microscopic examination, 88% of cases of group (A) showed no abnormalities in ciliated epithelial cells. only 12% of cases showed abnormalities in the form of damage in the ciliated cells with an architectural rearrangement. In group (B) 78% of patients showed abnormalities in cilia and epithelial cell damage and only 22% of them showed no abnormalities. Conclusion: Radiofrequency thermal ablation (RFTA) seems to be a good modality dealing with the problem of inferior turbinate hypertrophy. It showed minimal injury to turbinate mucosal tissues with good ciliary structure, along with an intact and functioning epithelium

Enlargement of inferior nasal turbinates is a common cause of nasal obstruction. Surgical methods used to treat hypertrophied inferior turbinates such as electrocautery, cryosurgery, partial turbinectomy, laser turbinoplasty, microdebrider reduction and radiofrequency thermal ablation (RFTA).The mucosal condition after surgery is an important factor that should be considered in evaluation of different techniques. This study aimed to examine the microstructural appearance of the ciliated epithelial tissues by light microscope.It was done by cytological examination of inferior turbinate mucosain patients treated by radiofrequency thermal ablation (RFTA) and bipolar electrocautery (BEC) of hypertrophied inferior turbinates. A prospective study included thirty six patients with hypertrophied inferior turbinates causing nasal obstruction not responding to medical treatment. Patients were divided into two groups: group(A) were managed with radiofrequency thermal ablation (RFTA)and group (B)were managed with bipolar electrocautery (BEC).Routine nasal examination was done with the aids of anterior rhinoscopy and nasal endoscopy. The postoperative follow up period wasthree months. cytological examination of nasal mucosa was done postoperatively. Results: there was no abnormalities in ciliated epithelial cells and only 12% of cases showed abnormalities in the form of damage in the ciliated cellswith anarchitectural rearrangement.While, the majority of sample showed abnormalities in cilia and epithelial cell damage. 78% of patients had abnormal ciliated epithelial cells im group B. Radiofrequency thermal ablation seems to be a good modality dealing with the problem of inferior turbinate hypertrophy. It showed minimal injury to turbinatemucosal tissues with good ciliary structure, along with an intact and functioning epithelium.‏