The Lancet Commission on Global Surgery reports that 5 out of every 7 people in the world lack access to safe, affordable, and timely surgical care. The majority of these people live in resource-constrained settings where up to 50% of the population is made up of children. 1,2 Delivering anesthesia in this setting is beset with challenges which are intensified when one needs to ventilate a small child. Anesthesia is known to negatively affect respiratory drive, ventilatory/perfusion matching, and tidal breathing which can all potentially result in hypoxia, and respiratory adverse events are reported as one of the leading causes of perioperative morbidity and mortality in children. 3,4 This educational review presents a brief overview of the challenges of providing anesthesia care for children in a resourceconstrained setting. Deficiencies in equipment, its implication for practice differences specifically related to intraoperative ventilation of small children and some proposed context-sensitive solutions are discussed. | OVERVIE WInternational standards detailing necessary facilities, equipment, monitoring, medications, and workforce required for the safe practice of anesthesia care have been previously described. 5 In resourceconstrained settings these standards are often not met and this problem is exacerbated by a paucity of well-trained surgical and anesthesia providers. 1,6 Anesthesiologists tend to be concentrated in urban centers with non-physician anesthesia providers (NPAP) providing much of the anesthesia care in the rural areas. For a multitude

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