[Spinal anesthesia in Africa. Risks, precautions]

Practice of anaesthesia in Africa rural zones needs adaptation to its peculiarities: pathology abundance, equipment and skilled staff shortage, medical and surgical acts delegation. It is high risk anaesthesia to do in a perspective of public health. Spinal anaesthesia, simple and cheap, is the technique of choice used for 86% of operations in our hospital. However it may induce sympathetic tone abolishment with marked falls in blood pressure and even cardiac arrest. To suppress the part of chance in this high risk context, we have made repetitive sympathetic perturbations prophylaxis, thanks to 2 protocoles. One issued from "saddle-block" allows genital and below surgery. Main worry is to get sure sensitive level, below D10. We use hyperbare technique, so blood pressure falls are less than 5%. The other is for abdominal surgery. Main worry is hypotension prophylaxis and management. We use hypobare technique, which allows Trendelenburg position with low cost and low risk autotransfusion. Other measures to reduce incidence of hypotension include prophylactic administration of atropine, ephedrine, and oxygen during the installation of anaesthesia.