Anaesthesia in underdeveloped world: Present scenario and future challenges

Bharati, Sachidanand Jee; Chowdhury, Tumul; Gupta, Nishkarsh; Schaller, Bernhard; Cappellani, Ronald B.; Maguire, Doug

doi:10.4103/0300-1652.128146

Cited by 40 publications

(25 citation statements)

References 46 publications

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“…In addition, in 2014, the density of the health professionals (surgeons, anesthesiologists and obstetricians) was 34.7 per 100,000 inhabitants in Brazil [ 38 ], while developed countries have an average of 56.9 of these professionals per 100,000 inhabitants [ 40 ]. These factors, combined with limited resources and numbers of surgical beds and operating rooms and increasing costs of surgery and anesthesia, seem to result in an important consequence: high perioperative CA and mortality rates in developing countries [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…Human resources are pivotal; the number and the education and training of both anesthesiologists and surgeons must be increased [ 41 , 42 ]. Preoperative management must be optimized; multidisciplinary discussions of adverse effects must be prompted; the provision of new monitoring techniques (e.g., pulse oximetry, capnography, echocardiography), modern anesthetic drugs, anesthesia equipment and workstations must be addressed universally; and practice guidelines and checklists in surgery and anesthesia as well as a structured approach to reducing errors must be adopted [ 41 – 45 ]. The mandatory period in the postanesthesia care unit should also be expanded, and the number of intensive care beds for critical patients should be increased to minimize the occurrence of adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

et al. 2020

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Introduction Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. Methods A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. Results Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990–2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60–45.50) before 1990 to 17.61 (95% CI: 9.21–28.68) in 1990–2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64–23.24] pre-1990 to 25.40 [95% CI: 13.01–41.86] in 1990–2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29–17.86) to 3.90 (95% CI: 2.93–5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76–3.11] to 0.67 [95% CI: 0.09–1.66; P = 0.5404). Conclusions This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

et al. 2020

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“…Likewise, the increasing trend of corruption and neglect is related to the impaired healthcare systems in developing countries ( 25 ). Combination of mentioned contributing factors has a negative impact on morbidity and mortality in developing countries ( 24 , 28 ). To address this concern, the main focus of visiting anesthetic team should be to reduce total perioperative and anesthetic-related mortality with evidence-based best practice.…”

Section: Discussionmentioning

confidence: 99%

“…Establishing local sustainable pediatric cardiac centers in developing countries providing both initial and continued training has made the greatest impact on mortality rates in the last decade ( 18 ). It is worth remembering that adequate education of local team requires involvement of local and central government ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Challenges in Pediatric Cardiac Anesthesia in Developing Countries

Cvetković

2018

Front. Pediatr.

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Introduction: Approximately 90% of a million children worldwide born with congenital heart defect do not have an access to adequate pediatric cardiac care. The World Society for Pediatric and Congenital Heart Surgery, established in 2006 shifted the focus from providing individual pediatric cardiac care to developing global standards for the practice of pediatric cardiac surgery and professional education of the local teams.Materials and Methods: After recognizing the challenges of the local team regarding providing safe anesthesia and functioning as a broader team, we have focused our education on simplifying anesthetic procedures and advancing structured team approach. The appropriate selection of patients and simplifying anesthetic technique should be the standard of care. We introduced structured approach to daily education using just in time teaching, case based discussions and simple skill training simulation sessions. Furthermore, we enhanced team-training approach applying tools such as WHO surgical safety checklist and implementation manual, SAFE communication, introducing KDD with SMART aim, SCAMPs, advanced protocols of care and culture change tools.Results: Following a significant number of short missions to developing centers we have, within NGO, succeeded to support building and maintaining several local pediatric cardiac centers with structured approach to anesthesia and team building.Conclusion: The appropriate selection of patients is one of the most important contributing factors for decreasing morbidity and mortality rate in pediatric cardiac surgery patients. The anesthesia technique for pediatric cardiac procedures should be aimed at fast-track surgery, with early extubation as a goal. Regional blocks such as paravertebral and caudal should be considered for perioperative pain control. By introducing structured approach to daily education and by enhancing team-training approach we have contributed evolving sustainable pediatric cardiac centers in developing countries.

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“…The large hospitals received a high volume of obstetric and surgical cases and were plagued by delay resulting from too many patients and too few resources. This in turn led to high mortality rates ( 8 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Potisek

Hatch

Atito-Narh

et al. 2017

Front. Public Health

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Ghana, like other countries in sub-Saharan African, has limited access to surgery. One contributing factor is the inadequate number of anesthesia providers. To address this need, Kybele, Inc., a US-based non-governmental organization, partnered with the Ghana Health Service to establish the third nurse anesthesia training school (NATS) in Ghana. The school, based at Ridge Regional Hospital (RRH) in Accra, opened in October 2009. This paper describes the evolution of the training program and presents the curriculum. Second, the results of a voluntary survey conducted among the first four classes of graduates (2011–2014) are presented to determine their perceived strengths and gaps in training and to identify employment locations and equipment availability. Seventy-five of 93 graduates (81%) responded to the survey. The graduates reported working in 39 hospitals across 7 of the 10 regions in Ghana. Six providers (8%) worked alone and 16 (21%) were one of only two providers. Fifty-three providers (71%) had no physician anesthesiologist at their facility. Most providers had access to basic anesthesia equipment; however, there was limited access to emergency airway equipment. While most graduates felt that their training had prepared them for their current positions, 21% reported experiencing a patient death during anesthesia. The NATS at RRH has been sustained and most of the graduates are working in Ghana, filling an important void. Quality improvement and continuing education must be emphasized in an effort to reduce surgical morbidity and mortality in Ghana.

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Anaesthesia in underdeveloped world: Present scenario and future challenges

Cited by 40 publications

References 46 publications

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Challenges in Pediatric Cardiac Anesthesia in Developing Countries

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

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