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Department of Anesthesiology and Critical Care Medicine, DOCS Hospital, Goma, the Democratic Republic of Congo, Africa (Baelani) Department of Anesthesiology and General Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria, martin.duenser{at}uibk.ac.at (Dünser)
To the Editor:
In his article, Joshi (1) suggests benefits of intraoperative fluid restriction in gastrointestinal surgery. We would like to report our own experience with perioperative fluid management in abdominal surgery in a referral hospital in Goma, the Democratic Republic of Congo in Africa.
During the period from January to June 2005, a total of 69 abdominal surgeries were performed. Full data sets were available of 45 patients (65.2%) older than 16 yr who were enrolled into the analysis. Thirty-four patients (75.6%) were female. Mean age was 33 ± 11 yr. Table 1 presents details on intraoperative data and postoperative complications. Although most patients were dehydrated before surgery as a result of nonexistent prehospital medical care, the amount of fluids given during surgery was low.
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Although lower amounts of fluids during abdominal surgery have been reported (2), intraoperative fluid balance in our analysis was comparable to that reported by Kita et al. (3). When compared with studies evaluating restrictive intraoperative fluid strategies in abdominal surgery (4,5), hourly fluid administration was substantially lower in our patient population, even though intraoperative blood loss was higher than reported in other studies (2–5). This is likely because electrocoagulation was not available for most surgical procedures. Despite restricted use of intraoperative fluids, all patients had adequate urine output, and postoperative complications were rare. In view of highly limited logistical and infrastructural resources, the hospital mortality of our abdominal surgical patient population (2.2%) is very low for a sub-Sahara African setting (6).
Perioperative fluid restriction is a common practice in most sub-Saharan countries. Important reasons include limited hospital resources, patient inability to pay for hospital supplies, disruption of hospital services by war, and the demands placed by occasional epidemics. Because the presented hospital is supported by a Western organization and can therefore compensate for limited financial resources of individual patients, it is likely that intraoperative fluid therapy is even more restrictive in other sub-Saharan hospitals that do not receive external support.
References
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