POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.

Mitochondrial diseases, or encephalomyopathies, are an uncommon, heterogeneous group of disorders with variable clinical course and presentation. Many of these patients present for surgery, or undergo anaesthesia in the course of investigation of their illness. Unfortunately, little information exists on their management in anaesthetic texts and the literature. We report on the anaesthetic management of a paediatric patient with mitochondrial disease, and briefly discuss the pathophysiology and anaesthetic implications of these disorders.

Influential international organizations have historically published anaesthesia guidelines, but for the most part, without impacting substantial documentable changes or outcomes in low-income environments. This analysis, and subsequent recommendations, reviews the effectiveness of existing strategies for international guidelines, and proposes practical, step-wise implementation of patient safety approaches for LMICs.

The output of sevoflurane from a drawover system utilizing two Oxford Miniature Vaporizers (OMVs) in series has been shown in bench-testing to be predictable. We have shown that adequate anaesthesia can be achieved with one vaporizer in most situations if an intravenous induction is used. Occasionally a second vaporizer is necessary to deepen the level of anaesthesia. For an inhalational technique to be successful it is necessary to use both vaporizers from the outset. Under these conditions, adequate operating conditions are easily produced. The method could be useful in field or military applications.