To the Editor:
As French physicians frequently and currently deployed in Theater of Operations in Africa, we read with interest the article by Ariyo et al.1 reviewing the anesthesia care provided at Médecins Sans Frontières facilities between 2008 and 2014. Spinal anesthesia was the most common type of anesthetic technique (34,413 [45.56%]), with cesarean section being the most common type of procedure performed (26,091 [34.54%]). Wound surgeries represented another common procedure type included in this retrospective study (18,547 [24.55%]). In this context, perioperative deaths occurred in 72 (0.21%) cases of obstetrics/gynecology and urology surgery and in only seven (0.06%) cases of wound surgeries. Nevertheless, the authors did not provide any details regarding the causes of death or any details about the incidence of perioperative bleeding and perioperative blood management. Perioperative blood management refers to perioperative blood transfusion and adjuvant therapies.2 Perioperative blood transfusion addresses the preoperative, intraoperative, and postoperative administration of blood and blood components. Adjuvant therapies refer to drugs and techniques to reduce or prevent blood loss and the need for transfusion of allogeneic blood. Actually, postpartum hemorrhage and trauma-associated hemorrhage are both global public health issues. Indeed, fatal hemorrhage is the leading cause of death in postpartum and trauma contexts, especially in developing countries.3–5 After many years of experience in transfusion in military theater of operations, the French Military Health Service has developed dedicated guidelines for blood transfusion in exceptional situations. Since medical aid to the population is an important activity for forward surgical teams deployed in combat zones, we usually apply this doctrine for either civilian or combat casualties.6,7 This dedicated strategy for blood management refers to the early administration of hemostatic drugs (tranexamic acid), French Lyophilized Plasma transfusion, and whole-blood collection.8,9 To conclude, we would like to know if the authors could provide further details regarding incidences of hemorrhages and perioperative blood management (perioperative blood transfusion and adjuvant therapies) in the 79,383 anesthetic procedures performed on 75,536 patients, in 21 different countries, during the 6-yr study period. Especially, we would like to know what kinds of blood resources are available at Médecins Sans Frontières facilities.
The authors declare no competing interests.