Anaesthesia and typhiod perforation: an anaesthetist's experience

The acceptance of surgery as the best hope of survival in patients with typhoid perforation has greatly increased the role of the anaesthetist in the management of these patients. The purpose of this study was to review our anaesthetic experience in the management of patients with typhoid perforation over a period of 10 years (January 1988-December 1997). Ninety-five patients aged between 3 and 70 years were anaesthetized for surgery on account of typhoid perforation within the study period. More than three-quarter of them (78%) were in the ASA classification 3 and 4. All the patients had general anaesthesia with endotracheal intubation. Preoperative adverse events were recorded in 30 patients (31.6%) and mortality rate was 18.95%. Severe dehydration and ASA=4 were preoperative factors of statistical prognostic importance (P=0.03 and 0.00 respectively). We conclude that even though patients with typhoid perforation usually present in poor clinical state with high anaesthetic risk, a well conducted anaesthesia preceded by adequate resuscitation, still offers a good hope for fairly good surgical outcome. Anaesthetic management must ensure adequate oxygenation and perio-operative haemodynamic stability.