ObjectiveTo describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload.DesignDescriptive analysis using 10 years (2008–2017) of routine case-level data linked with routine programme-level data from surgical projects run exclusively by Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB).SettingProjects were in contexts of natural disaster (ND, entire expatriate team deployed by MSF-OCB), active conflict (AC) and stable healthcare gaps (HG). In AC and HG settings, MSF-OCB support pre-existing local facilities. Hospital facilities ranged from basic health centres with surgical capabilities to tertiary referral centres.ParticipantsThe full dataset included 178 814 surgical cases. These were categorised by most senior anaesthetic provider for the project, according to qualification: specialist physician anaesthesiologists, qualified nurse anaesthetists and uncertified anaesthesia providers.Primary outcome measureVolume and nature of surgical workload of different anaesthesia providers.ResultsFull routine data were available for 173 084 cases (96.8%): 2518 in ND, 42 225 in AC, 126 936 in HG. Anaesthesia was predominantly led by physician anaesthesiologists (100% in ND, 66% in AC and HG), then nurse anaesthetists (19% in AC and HG) or uncertified anaesthesia providers (15% in AC and HG). Across all settings and provider groups, patients were mostly healthy young adults (median age range 24–27 years), with predominantly females in HG contexts, and males in AC contexts. Overall intra-operative mortality was 0.2%.ConclusionOur findings contribute to existing knowledge of the nature of anaesthetic provision in humanitarian settings, while demonstrating the value of high-quality, routine data collection at scale in this sector. Further evaluation of perioperative outcomes associated with different models of humanitarian anaesthetic provision is required.

SummaryA revised edition of the guidelines of the Association of Anaesthetists of Great Britain and Ireland, for the pre-operative check of anaesthetic machines, was published in March 1997. A checklist based on the revised guidelines was used for the routine pre-operative checks of anaesthetic machines over a 6-week period in a district general hospital. One hundred and thirty-two checklists were completed. These were analysed for the time taken to complete the check and for the faults found in the anaesthetic machines. The mean time taken to complete a check was 6.8 min and the mean time taken to complete two consecutive checks, in the anaesthetic room and operating theatre, was 12.7 min. Carbon dioxide cylinders were present on the machines in 99 checks (75%), contrary to Association guidelines. Other faults were found in 40 checks (30.3%). The most frequent cause of faults was the oxygen analyser, faults being found in 15 checks. Other frequent faults were due to empty vaporisers or spare gas cylinders and the emergency oxygen bypass control.

SummaryA computerised database of operating theatre activity was used to estimate the costs of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Data retrieved for each procedure included the anaesthetic technique and drugs used, and the duration of anaesthesia, surgery and recovery. The costs of anaesthetic drugs and disposables, salary costs of the anaesthetic personnel and maintenance costs for anaesthetic equipment were considered. Drugs and disposables accounted for < 25% of the total cost of an anaesthetic. Anaesthetic times were 5 min longer for regional anaesthesia, but recovery times were 10 min shorter following regional anaesthesia for varicose vein surgery. Staff costs were dependent on the length of time each staff member spent with the patient. Although the number of cases was small, provision of a field block and sedation for inguinal hernia repair was considerably cheaper than other anaesthetic techniques.Keywords Anaesthetic costs: regional; general. Cost containment has become a priority in all areas of health care. Clinicians must work within tightly controlled budgets in spite of increasing demand for services, expectations of higher standards, and the introduction of new drugs and techniques. A common view is that anaesthetic costs are insignificant because they are a relatively small component of the total for each surgical episode. This is superficially true; the Audit Commission reported that anaesthetic services comprised only 3% of NHS trust expenditure [1]. However, this adds up to a large sum of money across the service. Anaesthesia for any surgical procedure involves a wide choice of drugs, techniques and monitoring procedures, each with very different cost implications. Selection of any particular method must be determined by the relative costs, as well as the clinical benefits, if the challenge of providing highquality care within limited resources is to be met.The cost of each anaesthetic is the sum of a number of components. Information about the price of drugs (the commonest focus for debate) is readily available, but choices based solely on drug acquisition costs ignore many other factors that contribute to the cost of an anaesthetic, including capital and recurrent expenditure on equipment, the prices of disposable equipment, and the salaries of the anaesthetist, anaesthetic assistant and recovery staff. Personnel costs are dependent on the time spent by the patient in the anaesthetic room, operating theatre and recovery area, each of which may be affected by the anaesthetic technique or drugs used. This study used data from a computerised database of operating theatre activity to compare the costs of general and regional anaesthesia for patients undergoing varicose vein and inguinal hernia surgery. Methods Data collectionThe Ninewells Hospital operating theatre management system was established in 1989 using the Financial Information Project (FIP) Galaxy Theatre System, a software package marketed by Sanderson GA Ltd (1±2 Venture Way, Aston Scien...

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