Anesthetic management and morbidity in thoracic surgery: Results of the first series in Togo


Pikabalo Tchetike
Damessane Lamboni
Sarakawabalo Assenouwe
Magnoudewa Poko
Ernest Ahounou
Amouki S. Tresor Anate
Kolme Dissoba
Hamza Doles Sama
Tabana Essohanam Mouzou


Introduction: Thoracic surgery is a specialty with specific anesthetic management requirements. This is a recent specialty in Togo, with a multi-skilled anesthetic team.

Aim: To describe the anesthetic management and morbidity of thoracic surgery.

Methods: A descriptive, prospective and observational study was conducted on a cohort of patients who underwent a thoracic surgery between June 1 and August 31, 2022, at the national referral hospital in Lomé. The study examined pre-anesthetic assessment, surgical, anesthetic, and postoperative data.

Results: Twenty-five patients with a mean age of 40 ±13 years were included. The surgery was elective in 69% of cases. The anesthetic assessment showed anemia (64%) and a reduced forced expiratory volume in one second (60%)

All patients were operated on under general anesthesia with controlled ventilation, including 64% of one-lung ventilation. Surgical procedures included pleural decortication (28%), pericardial drainage (16%), pneumonectomy (16%), and pulmonary lobectomy (12%).  Twenty-three patients (92%) experienced intraoperative complications, including arterial hypotension (80%), shock (56%), and hypoxia (24%).

Multimodal analgesia including paracetamol (100%), nefopam (92%), morphine (76%), paravertebral analgesia (20%), and thoracic epidural analgesia (8%), was used postoperatively.

Seventeen patients (68%) experienced postoperative complications, including anemia (20%), pneumonia (12%), and parietal infection (12%). Three patients (12%) died.

Conclusion: General anesthesia with, one-lung ventilation in most cases, was the anesthetic technique in thoracic surgery. Complications, mainly cardiovascular, occurred intraoperatively, with high postoperative mortality.


Thoracic surgery, pneumonectomy, anesthesia, One-lung ventilation, multimodal analgesia, morbidity, Togo, Africa



  1. Blank RS, Hucklenbruch C, Gurka KK, et al. Intraoperative factors and the risk of respiratory complications after pneumonectomy. Ann Thorac Surg. 2011; 92(4):1188‑94.
  2. Suehiro K, Okutani R, Ogawa S. Anesthetic considerations in 65 patients undergoing unilateral pneumonectomy: problems related to fluid therapy and hemodynamic control. J Clin Anesth. 2010;22(1):41‑4.
  3. Lung Cancer Clinical Outcome Publication 2017 (for the audit period 2015) [Internet]. RCP London. 2017 [cité 6 juin 2023]. Disponible sur:
  4. Rivera C, Arame A, Pricopi C, et al. Pneumonectomy for benign disease: indications and postoperative outcomes, a nationwide study. Eur J Cardio-Thorac Surg. 2015;48(3):435‑40.
  5. Ndiaye A, Banga Nkomo DD, Diatta S, et al. Indications et suites opératoires des pneumonectomies au Centre hospitalier universitaire national (CHUN) de Fann à Dakar. Journal de la SFCTCV. 2018;22(4).
  6. Nsiala MJ, Ngomba KS, Nzomvuama A, Kilembe MA, Kayembe Ntumba J-M. Pratique actuelle de l’anesthésie-réanimation pour thoracotomie dans un pays à ressources limitées : série de cas. Ann. Afr. Med. 2017;11(1):e2726. Congrès AFMED 2017. [Internet]. [Cité 6 juin 2023]. Disponible sur :
  7. Muñoz de Cabo C, Hermoso Alarza F, Cossio Rodriguez AM, Martín Delgado MC. Perioperative management in thoracic surgery. Med Intensiva. 2020;44(3):185‑91.
  8. Mouzou ET, Assenouwe S, Lamboni D, et al. Management of Thoracic Trauma in Intensive Care Unit in Togo: A Particular Reference to Sylvanus Olympio University Hospital of Lomé. Anesth Crit Care 2022;4(1):52-63.
  9. Abdoulhamidou A , Thierno D, Moustapha M, et al. Chest Trauma at the Emergency Department of the Gabriel Touré University Hospital Bamako, Mali. Open J. Emerg. Med 2021;9:18-24.
  10. Niang E.H.M, Bona DO, Diallo A, et al. Prise en charge du traumatisme thoracique à la réanimation de l’Hôpital Principal de Dakar/Sénégal. Rev. Afr. Anesthésiol.Med. Urgence 2017;22(1):47-52.
  11. Lamine B, Camara A, Bah A, Magassouba A, Maimouna B. Traumatisme fermé du thorax : aspects épidémiologiques et prise en charge au CHU de Conakry. Rev Int Sci Médicales Abidj. 2017;19:52‑6.
  12. Hackett S, Jones R, Kapila R. Anaesthesia for pneumonectomy. BJA Educ. 2019;19(9):297‑304.
  13. Nagarajan K, Bennett A, Agostini P, Naidu B. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg. 2011;13(3):300‑2.
  14. Ynineb Y, Mariaux de Serres T, Szymkiewicz O, Houhou A, Bonnet F. Prise en charge périopératoire des patients opérés du poumon. Prat En Anesth Réanimation 2013;17(3):147‑51.
  15. Masson E. Intubation en chirurgie pulmonaire. Le Praticien En Anesthésie Réanimation 2016; 20. [Internet]. [Cité 6 juin 2023]. Disponible sur:
  16. Michelet P, Hélaine A, Avaro JP, et al. Influence de la stratégie analgésique sur la fonction respiratoire après chirurgie thoracique pour lobectomie. Ann Fr Anesth Réanimation. 2007;26(5):405‑11.
  17. Micheleta P, Hélainea A, Avarob J-P, Guervillya C, Gaillata F, Kerbaula F, et al. Influence de la stratégie analgésique sur la fonction respiratoire après chirurgie thoracique pour lobectomie. Ann Fr Anesth Reanim 2007;26:405-11.
  18. Gottschalk A, Cohen S, Yang S, Ochroch E. Preventing and treating pain after thoracic surgery. Anesthesiology 2006;104:594-600.
  19. Gayraud G, Bastien O, Taheri H, Schoeffler P, Dualé C. Enquête sur les pratiques françaises d’analgésie en chirurgie thoracique (réalisée avec le concours de l’ARCOTHOVA). Ann Fr Anesth Reanim 2O13;32(10):684-90.
  20. Kammoun W, Mestiri T, Miraoui W, Frikha N, Mebazaa MS, Kilani T, et al. Interet de l’analgésie péridurale autocontrôlée en chirurgie thoracique. Tunis Med 2008;86(2):144-9.
  21. Bah MD, Ndiaye PI, Leye P A, Traoré MM, Diatta S. Les facteurs prédictifs de complications respiratoires après chirurgie pulmonaire : étude portant sur 126 patients opérés au CHU de FANN de Dakar. Rev Afr Anesth Med Urg 2017;22(1):35-40.
  22. Brunelli A, Ferguson MK, Rocco G, et al. A scoring system predicting the risk for intensive care unit admission for complications after major lung resection: a multicenter analysis. Ann Thorac Surg 2008;86(1):213‑8.
  23. De Decker K, Jorens PG, Van Schil P. Cardiac complications after noncardiac thoracic surgery: an evidence-based current review. Ann Thorac Surg. 2003;75(4):1340‑8.