1
|
Mohamed M, Grimm A, Williams C, Cotache-Condor C, Concepcion TL, Dahir S, Ismail EA, Rice HE, Smith ER. Assessment of anesthesia capacity for children in Somaliland. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003650. [PMID: 39196977 PMCID: PMC11356410 DOI: 10.1371/journal.pgph.0003650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/05/2024] [Indexed: 08/30/2024]
Abstract
The burden of pediatric surgical conditions in Somaliland is high and the pediatric anesthesia capacity across the country remains poorly understood. The international standards developed by the World Health Organization and World Federation of Societies of Anaesthesiologists (WHO-WFSA) serve as a guideline to assess the provision of anesthetic care. This study aims to describe anesthesia capacity for children in Somaliland and assess progress towards reaching the WHO-WFSA international standards. In this cross-sectional study, anesthesia infrastructure and workforce data, as well as pediatric clinical and demographic data were collected from fifteen private, charity, and government hospitals in the six regions of Somaliland. We described anesthesia capacity in Somaliland and compared baseline data to the WHO-WFSA international standards. Overall, Somaliland did not reach most of the target goals for anesthesia capacity as defined by the WHO-WFSA. Most markers for anesthesia capacity were far behind the established targets, with deficits of 99% for anesthesiologists density, 83% for operating room density, and 83% for ventilator density. Hospitals in urban Maroodi-Jeex, and private hospitals had more supplies, infrastructure, and surgical personnel than hospitals in rural areas. There are large gaps in current anesthetic resources for children according to WHO-WFSA global standards, as well as wide disparities between regions and types of hospitals in Somaliland. Increased investment in anesthesia infrastructure and workforce is required to meet the needs of pediatric surgical patients across the country.
Collapse
Affiliation(s)
- Mubarak Mohamed
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Andie Grimm
- Institute for Cancer Outcomes and Survivorship, University Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Christina Williams
- Program in Pediatrics and Anesthesiology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Cesia Cotache-Condor
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Tessa L. Concepcion
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Shukri Dahir
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Edna Adan Ismail
- Founder and Director, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Henry E. Rice
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Emily R. Smith
- Duke Center for Global Surgery and Health Equity, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University, Durham, North Carolina, United States of America
| |
Collapse
|
2
|
Nizeyimana F, Skelton T, Bould MD, Beach M, Twagirumugabe T. Perioperative Anesthesia-Related Complications and Risk Factors in Children: A Cross-Sectional Observation Study in Rwanda. Anesth Analg 2024; 138:1063-1069. [PMID: 37678238 DOI: 10.1213/ane.0000000000006641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Despite an increasing awareness of the unmet burden of surgical conditions, information on perioperative complications in children remains limited especially in low-income countries such as Rwanda. The objective of this study was to estimate the prevalence of perioperative anesthesia-related adverse events and to explore potential risk factors associated with them among pediatric surgical patients in public referral hospitals in Rwanda. METHODS Data were collected for all patients under 5 years of age undergoing surgery in 3 public referral hospitals in Rwanda from June to December 2015. Patient and family history, type of surgery, comorbidities, anesthesia technique, intraoperative adverse events and postoperative events in the postanesthesia care unit (PACU) were recorded. The incidence of perioperative adverse events was assessed and associated risk factors analyzed with univariate logistic regression. RESULTS Of 354 patients enrolled in this study 11 children had a cardiac arrest. Six (1.7%) suffered an intraoperative cardiac arrest, 2 of whom (0.6%) died intraoperatively. In the PACU, 6 (1.8%) suffered a postoperative cardiac arrest, 5 of whom (1.5%) died in the PACU. One child had both an intraoperative cardiac arrest and then a cardiac arrest in PACU but survived. Eighty-nine children (25.1%) had an intraoperative adverse event, whereas 67 (20.6%) had an adverse event in PACU. A review of the cases where cardiac arrest or death occurred indicated that there were significant lapses in the expected standard of care. Age <1 week was associated with cardiac arrest or death. CONCLUSIONS The rate of perioperative complications, including death, for children undergoing surgery in tertiary care hospitals in Rwanda was high. Quality improvement measures are needed to decrease this rate among surgical pediatric patients in this low resource setting.
Collapse
Affiliation(s)
- Francoise Nizeyimana
- From the Department of Anesthesia and Critical Care, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Teresa Skelton
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Dylan Bould
- Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Beach
- Department of Anesthesiology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Theogene Twagirumugabe
- Department of Anaesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Anesthesiology and Pain Medicine, Critical Care and Emergency Medicine, University of Rwanda, Butare, Rwanda
| |
Collapse
|
3
|
Duangkum C, Sirikarn P, Kongwattanakul K, Sothornwit J, Chaiyarah S, Saksiriwuttho P, Somjit M, Komwilaisak R, Hayagangchart S, Lumbiganon P. Subcutaneous vs intravenous fentanyl for labor pain management: a multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101310. [PMID: 38342306 DOI: 10.1016/j.ajogmf.2024.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. OBJECTIVE This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. STUDY DESIGN We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. RESULTS Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. CONCLUSION Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.
Collapse
Affiliation(s)
- Chatuporn Duangkum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon).
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand (Dr Sirikarn)
| | - Kiattisak Kongwattanakul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Jen Sothornwit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Sothornwit)
| | - Sukanya Chaiyarah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Piyamas Saksiriwuttho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Monsicha Somjit
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Somjit)
| | - Rattana Komwilaisak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Suppasiri Hayagangchart
- Department of Obstetrics and Gynecology, Khon Kaen Hospital, Khon Kaen, Thailand (Dr Hayagangchart)
| | - Pisake Lumbiganon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| |
Collapse
|
4
|
Shahbaz S, Howard N. Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001953. [PMID: 38498415 PMCID: PMC10947636 DOI: 10.1371/journal.pgph.0001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a scoping review of primary and secondary research literature on capacity and effectiveness of anaesthesia delivery in low and lower middle-income countries in the Asia region from 2000-2021, to clarify existing knowledge, important gaps, and possible subsequent steps. We applied Arksey and O'Malley's scoping literature review method to search five databases (i.e. EMBASE, CINAHL, Medline, Scopus, Web of Science), screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g. central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training, and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.
Collapse
Affiliation(s)
- Sumbal Shahbaz
- Department of Health Professional Technologies, The University of Lahore, Lahore, Pakistan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
5
|
Mohamed AI, Bashir MS, Taha SM, Hassan YM, Al Zhranei RM, Obaid AA, Albarakati AM. A Cross-Sectional Study of Anesthesia Safety in Wad Medani, Sudan: A Pre-war Status Indicating a Post-war Crisis. Cureus 2024; 16:e56725. [PMID: 38646214 PMCID: PMC11032737 DOI: 10.7759/cureus.56725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND As the surgical burden grows, increasing patient safety during anesthesia and surgery becomes a major global public health priority. Anesthesia can be safely administered in higher-income countries, yet it is more challenging in third-world countries. This study focuses on Sudan, a third-world country, and its unmet anesthetic needs before the current war and how these needs might compromise the post-war status. AIM The aim of this study is to compare Sudan's outstanding anesthesia requirements to the World Health Organization's safe anesthesia practice standards in terms of workforce, medications, equipment, and anesthesia conduct. METHODS This study was carried out in four hospitals (Wad Medani Teaching Hospital, Wad Medani Maternity Hospital, Gezira Centre for Renal and Urological Surgeries, and the National Centre for Pediatric Surgeries) in Wad Medani, two of which were referral and two were state-run. Each hospital from every category was identified using a convenience sampling technique. The World Health Organization-World Federation of Societies of Anesthesiologists International Standard and earlier regional African publications were used to determine the minimum predicted safe anesthesia needs. RESULTS The results of our study demonstrate that overall, the hospitals surveyed fulfilled the minimum standards set by the World Health Organization and the World Federation of Societies of Anesthesiologists (WHO-WFSA) for safe anesthesia practice by 73% with no significant difference in the safety of anesthesia practice between state and referral hospitals. CONCLUSIONS The state of safe anesthesia care in Wad Medani hospitals surveyed fell well short of the expected minimal criteria due to important requirements such as patient monitoring indicators, the inaccessibility of life-saving facilities such as defibrillators, and difficult intubation instruments. More importantly, the conduct of anesthesia was far below the standard.
Collapse
Affiliation(s)
- Alaa I Mohamed
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed S Bashir
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sami M Taha
- Department of Urology, University of Gezira, Wad Medani, SDN
- Department of Urology, Gezira Hospital for Renal and Urological Surgeries, Wad Medani, SDN
| | - Yassir M Hassan
- Department of Obstetrics and Gynaecology, University of Gezira, Wad Medani, SDN
- Obstetrics and Gynecology, Wad Medani Maternity Hospital, Wad Medani, SDN
| | - Raid M Al Zhranei
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmad A Obaid
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrahman M Albarakati
- Department of Anesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| |
Collapse
|
6
|
Díaz-Kruik P, Paradisi F. Rapid production of the anaesthetic mepivacaine through continuous, portable technology. GREEN CHEMISTRY : AN INTERNATIONAL JOURNAL AND GREEN CHEMISTRY RESOURCE : GC 2024; 26:2313-2321. [PMID: 38380269 PMCID: PMC10875724 DOI: 10.1039/d3gc04375d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Local anaesthetics such as mepivacaine are key molecules in the medical sector, so ensuring their supply chain is crucial for every health care system. Rapid production of mepivacaine from readily available commercial reagents and (non-dry) solvents under safe conditions using portable, continuous apparatus could make an impactful difference in underdeveloped countries. In this work, we report a continuous platform for synthesising mepivacaine, one of the most widely used anaesthetics for minor surgeries. With a focus on sustainability, reaction efficiency and seamless implementation, this platform afforded the drug in 44% isolated yield following a concomitant distillation-crystallisation on a gram scale after N-functionalisation and amide coupling, with full recovery of the solvents and excess reagents. The use of flow chemistry as an enabling tool allowed the use of "forbidden" chemistry which is typically challenging for preparative and large scale reactions in batch mode. Overall, this continuous platform presents a promising and sustainable approach that has the potential to meet the demands of the healthcare industry.
Collapse
Affiliation(s)
- Pablo Díaz-Kruik
- Department of Chemistry, Biochemistry and Pharmacology, University of Bern Freistrasse 3 Bern Switzerland
| | - Francesca Paradisi
- Department of Chemistry, Biochemistry and Pharmacology, University of Bern Freistrasse 3 Bern Switzerland
| |
Collapse
|
7
|
Molla MT, Anley NS, Zewdie BW, Endeshaw AS, Kumie FT. 28-day perioperative pediatric mortality and its predictors in a tertiary teaching hospital in Ethiopia: a prospective cohort study. Eur J Med Res 2024; 29:24. [PMID: 38183106 PMCID: PMC10768305 DOI: 10.1186/s40001-023-01613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Perioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up. METHODS The data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance. RESULTS There were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality. CONCLUSIONS In this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.
Collapse
Affiliation(s)
- Misganew Terefe Molla
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Nebiyu Shitaye Anley
- Department of Surgery, Pediatric Surgery Unit, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bekalu Wubshet Zewdie
- Department of Orthopedics and Traumatology, Pediatric Orthopedic Unit, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Tarekegn Kumie
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
8
|
Gathuya Z, Nabukenya MT, Aaron O, Gray R, Evans FM. Children's Anaesthesia and perioperative care challenges, and innovations. Semin Pediatr Surg 2023; 32:151355. [PMID: 38043262 DOI: 10.1016/j.sempedsurg.2023.151355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2-4) Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5-7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).
Collapse
Affiliation(s)
- Z Gathuya
- Department of Anesthesia, The Nairobi Hospital, Nairobi, Kenya.
| | - M T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Uganda
| | - O Aaron
- Department of Anesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27St Michaels Rd, Tamboerskloof, Cape Town, 8001, South Africa
| | - F M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| |
Collapse
|
9
|
Sherwani M, Abib S, Samad L. Barriers and challenges to achieving equity in global children's surgery: A call to action. Semin Pediatr Surg 2023; 32:151346. [PMID: 38041909 DOI: 10.1016/j.sempedsurg.2023.151346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
CHALLENGES A Call to Action.
Collapse
Affiliation(s)
| | - Simone Abib
- Federal University of São Paulo (UNIFESP) - Paulista School of Medicine, Pediatric Oncology Institute - GRAACC/UNIFESP
| | | |
Collapse
|
10
|
Abubakar AI, Okpechi SC, Euguagie OO, Ikpambese AA. Demographics and Clinical Characteristics of Burn Injuries in Nigeria: A Tertiary Hospital Cohort. Niger J Clin Pract 2023; 26:1916-1920. [PMID: 38158361 DOI: 10.4103/njcp.njcp_470_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/31/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Burn injuries account for 4.8% of trauma deaths in Nigeria and annually for 20,000 deaths. AIM This study was to catalogue the demographics of patient who presented at a referral center in Nigeria. PATIENTS AND METHODS In a retrospective study, we reviewed the records of all burn patients who presented over a 36-month period (January 2018 to December 2020). The clinical and demographic data was extracted using a self-designed questionnaire. Information obtained included biodata, etiology, time of presentation, first aid used, TBSA, length of hospital stay (LOHS), and outcome which was analyzed with SPSS version 28. RESULTS A total of 112 burn patients presented at our facility, 87 male and 25 female (m: f = 3.5:1). Forty-four percent were children 10 years old and below. Though scalding with hot liquids was the commonest cause of injury in children, flame burn was the commonest etiology (57.1%). Inhalational injuries occurred in 14.2%. Raw eggs and pap were used as first aid by 23%. Most patients were discharged home, and 19.6% died. CONCLUSION The prevalence of burn injuries remains high in developing countries. Most causes of burns are preventable. Dangerous traditional practices add to patient morbidity. Education on effective prevention strategies is important in reducing morbidity and mortality.
Collapse
Affiliation(s)
- A I Abubakar
- Department of Surgery, University of Abuja, Abuja, Nigeria
| | - S C Okpechi
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - O O Euguagie
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - A A Ikpambese
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| |
Collapse
|
11
|
Powell WF, Echeto-Cerrato MA, Gathuya Z, Gray RM, Hodges S, Nabukenya MT, Newton MW, Rai E, Evans FM. Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low- and Middle-Income Countries. World J Surg 2023; 47:3429-3435. [PMID: 37891383 DOI: 10.1007/s00268-023-07229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low- and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed. METHODS A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions. RESULTS AND CONCLUSIONS There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, large-scale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.
Collapse
Affiliation(s)
- William Francis Powell
- Department of Anesthesiology, Harvard Medical School, Mass Eye and Ear243 Charles Street, Boston, MA, 02114, USA.
| | - Maria Alejandra Echeto-Cerrato
- Department of Anesthesiology and Pediatrics, Hospital del Valle North Blvd, 8Th Street NE, San Pedro Sula, Honduras, 21101
| | | | - Rebecca Mary Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27 St Michaels Rd, Tamboerskloof, Cape Town, 8001, Republic of South Africa
| | | | - Mary T Nabukenya
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Upper Mulago Hill Rd, Kampala, Uganda
| | - Mark W Newton
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ekta Rai
- Department of Anaesthesiology, Christian Medical College, Vellore, India, 632004
| | - Faye M Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
12
|
Bulamba F, Connelly S, Richards S, Lipnick MS, Gelb AW, Igaga EN, Nabukenya MT, Wabule A, Hewitt-Smith A. A Cross-Sectional Survey of Anesthetic Airway Equipment and Airway Management Practices in Uganda. Anesth Analg 2023; 137:191-199. [PMID: 37115721 DOI: 10.1213/ane.0000000000006278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant contributor to perioperative morbidity and mortality. While existing data have highlighted the magnitude of airway management complications in LMICs, there are inadequate data to understand their root causes. This study aimed to pilot an airway management capacity tool that evaluates airway management resources, provider practices, and experiences with difficult airways in an attempt to better understand potential contributing factors to airway management challenges. METHODS We developed a novel airway management capacity assessment tool through a nonsystematic review of existing literature on anesthesia and airway management in LMICs, internationally recognized difficult airway algorithms, minimum standards for equipment, the safe practice of anesthesia, and the essential medicines and health supplies list of Uganda. We distributed the survey tool during conferences and workshops, to anesthesia care providers from across the spectrum of surgical care facilities in Uganda. The data were analyzed using descriptive methods. RESULTS Between May 2017 and May 2018, 89 of 93 surveys were returned (17% of anesthesia providers in the country) from all levels of health facilities that provide surgical services in Uganda. Equipment for routine airway management was available to all anesthesia providers surveyed, but with a limited range of sizes. Pediatric airway equipment was always available 54% of the time. There was limited availability of capnography (15%), video laryngoscopes (4%), cricothyroidotomy kits (6%), and fiber-optic bronchoscopes (7%). Twenty-one percent (18/87) of respondents reported experiencing a "can't intubate, can't ventilate" (CICV) scenario in the 12 months preceding the survey, while 63% (54/86) reported experiencing at least 1 CICV during their career. Eighty-five percent (74/87) of respondents reported witnessing a severe airway management complication during their career, with 21% (19/89) witnessing a death as a result of a CICV scenario. CONCLUSIONS We have developed and implemented an airway management capacity tool that describes airway management practices in Uganda. Using this tool, we have identified significant gaps in access to airway management resources. Gaps identified by the survey, along with advocacy by the Association of Anesthesiologists of Uganda, in partnership with the Ugandan Ministry of Health, have led to some progress in closing these gaps. Expanding the availability of airway management resources further, providing more airway management training, and identifying opportunities to support skilled workforce expansion have the potential to improve perioperative safety in Uganda.
Collapse
Affiliation(s)
- Fred Bulamba
- From the Department of Anesthesia & Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Stephanie Connelly
- Department of Anesthesia, Hereford County Hospital, Wye Valley NHS Trust, Hereford, United Kingdom
| | - Sara Richards
- Department of Anesthesia, Perioperative and Pain Medicine, Kaiser Permanente San Diego, San Diego, California
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Adrian W Gelb
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Elizabeth N Igaga
- Department of Anesthesia, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mary T Nabukenya
- Department of Anesthesia, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Wabule
- Department of Anesthesia, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adam Hewitt-Smith
- From the Department of Anesthesia & Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| |
Collapse
|
13
|
Vila Moutinho Tavares S, Tavares JC, Borges Marques J, Teixeira de Figueiredo J, Passos de Souza RL. Ketamine-dexmedetomidine combination for sedation in pediatric major surgery in a low-income country. Paediatr Anaesth 2023; 33:278-281. [PMID: 35445494 DOI: 10.1111/pan.14465] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
Anorectal malformations are one of the most frequent congenital malformations treated by pediatric surgeons. In low-income countries, the surgical and anesthetic management of children in need of these procedures can be challenging. Limited oxygen supply, lack of equipment, especially pediatric, and intensive care units make the use of regional anesthesia appealing. We present a series of four cases of anorectal malformations corrections in Guinea Bissau, in children up to 13 months of age, under regional anesthesia and sedation with ketodex, a mixture of ketamine and dexmedetomidine (in a proportion of 1 mg to 1 μg). No child developed respiratory depression requiring airway intervention or supplemental oxygen, or had hemodynamic instability.
Collapse
Affiliation(s)
| | - João C Tavares
- Department of Anesthesiology 1, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | | | | | - Renato Lucas Passos de Souza
- Department of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, HCFMRP-USP, Ribeirão Preto, Brazil
| |
Collapse
|
14
|
Puvanachandra P, Ssesumugabo C, Balugaba BE, Ivers R, Kobusingye O, Peden M. The epidemiology and characteristics of injuries to under 5's in a secondary city in Uganda: a retrospective review of hospital data. Int J Inj Contr Saf Promot 2022; 29:550-555. [PMID: 35797975 DOI: 10.1080/17457300.2022.2089686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Child injuries are largely preventable yet cause significant mortality and morbidity globally. Injury data from low-income countries is limited for children under the age of 5 and therefore the current understanding of the magnitude of injuries in this age group is low. Hospital-based registries are one mechanism by which injury data can be gathered. This paper presents findings from a retrospective hospital record review of 4 hospitals in Jinja, a rural setting in Uganda, involving the extraction of data for children under the age of 5-years who sustained an injury during a 6-month period in 2019. A total of 225 injury cases were retrieved from the hospitals. Over half (57.3%) of the events occurred among males. The majority (92%) suffered one injury per injury event. Most of the injuries occurred among those aged 13 to 24 months (32.9%). Burns (32%) and cuts (20%) were the most common cause of injury. This study presents a hospital-based analysis of injuries amongst under 5's in rural Uganda. It provides information on the characteristics of children entering healthcare facilities in Uganda and highlights the burden of paediatric injuries in the hospital setting.
Collapse
Affiliation(s)
- P Puvanachandra
- The George Institute for Global Health, UK, Imperial College London, London, UK
| | - C Ssesumugabo
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - B E Balugaba
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - R Ivers
- School of Population Health, University of New South Wales, Sydney, Australia
| | - O Kobusingye
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - M Peden
- The George Institute for Global Health, UK, Imperial College London, London, UK
| |
Collapse
|
15
|
Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training. BMC Health Serv Res 2022; 22:1395. [PMID: 36419106 PMCID: PMC9682720 DOI: 10.1186/s12913-022-08698-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists' perioperative care and what, if any, capacity gaps remain. METHODS We identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa > 0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care. RESULTS Ten of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial. CONCLUSION Among a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.
Collapse
|
16
|
Sheikdon AA, Mulepo P, Waiswa G, Bugeza S, Sereke SG, Mfaume B, Patrick S, Jada SA, Emusugut M. Short-Term Management Outcomes of Supracondylar Fractures of the Humerus and Their Associated Factors in Children Managed at Mulago National Referral Hospital. Orthop Res Rev 2022; 14:235-245. [PMID: 35875360 PMCID: PMC9297100 DOI: 10.2147/orr.s370357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdirizak Abdullahi Sheikdon
- Orthopedic Department, Makerere University, Kampala, Uganda
- Correspondence: Abdirizak Abdullahi Sheikdon; Philip Mulepo, Kampala, Uganda, Tel +252 6 15896182, Email ;
| | - Phillip Mulepo
- Orthopedic Department, Makerere University, Kampala, Uganda
| | - Gonzaga Waiswa
- Orthopedic Department, Makerere University, Kampala, Uganda
| | - Samuel Bugeza
- Department of Radiology and Radiotherapy, Makerere University, Kampala, Uganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, Makerere University, Kampala, Uganda
| | | | - Sali Patrick
- Orthopedic Department, Makerere University, Kampala, Uganda
| | | | | |
Collapse
|
17
|
Holmaas G, Abate A, Woldetsadik A, Hevrøy O. Establishing a sustainable training programme in anaesthesia in Ethiopia. Acta Anaesthesiol Scand 2022; 66:1016-1023. [PMID: 35749233 PMCID: PMC9541354 DOI: 10.1111/aas.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Background Lack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low‐income countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care. Methods Between 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia‐training programme at Addis Ababa University/Tikur Anbessa Specialised Hospital in Ethiopia. The aim of the programme was to build a self‐sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme. Results Since the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within 3 years. Conclusion Nearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.
Collapse
Affiliation(s)
- Gunhild Holmaas
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Olav Hevrøy
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
18
|
Tuyishime E, McIsaac DI, Mumbwe MC, Ruhato Banguti P, Mvukiyehe JP, Nzarora J, Bould MD. Burnout Syndrome Among Anesthesia Providers Working in Public Hospitals in Rwanda: A Cross-Sectional Survey. Anesth Analg 2022; 135:820-828. [PMID: 35452008 DOI: 10.1213/ane.0000000000006053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many studies address anesthesia provider burnout in high-income countries; however, there is a paucity of data on burnout for anesthesia providers in low-income countries (LICs). Our objectives were (1) to evaluate the prevalence of burnout among anesthesia providers in Rwandan hospitals and (2) to determine factors associated with burnout among anesthesia providers in Rwandan hospitals. METHODS A questionnaire was sent to selected Rwandan anesthesia providers working in public hospitals. The questionnaire assessed burnout using the Maslach Burnout Inventory Human Services Survey, a validated 22-item survey used to measure burnout among health professionals. Sociodemographic and work-related factors found to be associated with burnout were also assessed using logistic regression in a Bayesian framework to estimate odds ratios (OR) and associated credible intervals (CrIs). RESULTS Surveys were distributed to 137 Rwandan anesthesia providers; 99 (72.3%) were returned. Sixty-six (67%) respondents were nonphysician anesthesia providers. Burnout was present in 26 of 99 (26.3%) participants (95% confidence interval [CI], 17.9-36.1). When considering weakly informative priors, we found a 99% probability that not having the right team (OR, 5.36%; 95 CrI, 1.34-23.53) and the frequency of seeing patients with negative outcomes such as death or permanent disability (OR, 9.62; 95% CrI, 2.48-42.84) were associated with burnout. CONCLUSIONS In a cross-sectional survey of anesthesia providers in Rwanda, more than a quarter of respondents met the criteria for burnout. Lacking the right team and seeing negative outcomes were associated with higher burnout rate. These identified factors should be addressed to prevent the negative consequences of burnout, such as poor patient outcomes.
Collapse
Affiliation(s)
- Eugene Tuyishime
- From the Department of Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Kigali, Rwanda.,Department of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mbangu C Mumbwe
- Department of Anesthesia, Ndola Teaching Hospital, Ministry of Health, Ndola, Zambia
| | - Paulin Ruhato Banguti
- From the Department of Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Jean Paul Mvukiyehe
- From the Department of Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Josue Nzarora
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - M Dylan Bould
- Department of Anesthesia and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Evans FM, Wake PB, Gathuya ZN, McDougall RJ. Access to Safe Pediatric Anesthesia in LMICs-The Problem Is Clear; It Is Time to Solve It! Anesth Analg 2022; 134:724-727. [PMID: 35299212 DOI: 10.1213/ane.0000000000005924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Faye M Evans
- From the Department of Anesthesiology, Critical Care, and Pain Medicine and Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Pauline B Wake
- Discipline of Anaesthesiology and Intensive Care, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | | | - Robert J McDougall
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, the Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Gallifant J, Sharell D, Hashmi M, Riviello ED, Schultz MJ, Ulisubisya MM, Formenti F. Mechanical ventilators for low- and middle-income countries: informing a context-specific and sustainable design. Br J Anaesth 2022; 128:e279-e281. [PMID: 35151463 PMCID: PMC8828371 DOI: 10.1016/j.bja.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/11/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jack Gallifant
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Dan Sharell
- Rotterdam School of Management, Erasmus University, Rotterdam, the Netherlands
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Elisabeth D Riviello
- Harvard Medical School, and Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine Mahidol University, Bangkok, Thailand; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - Federico Formenti
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA; Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK.
| |
Collapse
|
21
|
Ndikontar Kwinji R, Evans F, Gray RM. Challenges with pediatric anesthesia and intraoperative ventilation of the child in the resource-constrained setting. Paediatr Anaesth 2022; 32:372-379. [PMID: 34861089 DOI: 10.1111/pan.14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Abstract
The systemic challenges in providing safe anesthesia, including safe ventilation, to children in resource-constrained settings are many. For anesthesia providers caring for children, the lack of appropriate equipment, inadequate anesthesia workforce and deficiencies in postoperative care are especially difficult. The clinical decisions made by anesthesia providers around when and how to ventilate a child for surgery are influenced by all of these factors and can result in patient management which may vary significantly from that in a high-resource setting. This educational review considers the intraoperative ventilation of a small child in a resource-constrained setting and discusses specific challenges and context-sensitive solutions.
Collapse
Affiliation(s)
- Raymond Ndikontar Kwinji
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Department of Anesthesia and Intensive Care, Yaounde Gyneco Obstetric and Pediatric Hospital, Yaounde, Cameroon
| | - Faye Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca M Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa.,Division of Global Surgery, Department of Surgery, University of Cape Town, Rondebosch, South Africa
| |
Collapse
|
22
|
Gray RM, Cronjé L, Kalipa MN, Lee CA, Evans FM. Paediatric anaesthesia care in Africa: challenges and opportunities. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.1.2767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- RM Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
- Division of Global Surgery, Department of Surgery, University of Cape Town,
South Africa
| | - L Cronjé
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal,
South Africa
| | - MN Kalipa
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria,
South Africa
| | - CA Lee
- Department of Paediatric Anaesthesia, Nelson Mandela Children’s Hospital and Department of Anaesthesiology, University of the Witwatersrand,
South Africa
| | - FM Evans
- Boston Children’s Hospital, Department of Anesthesiology, Critical Care, and Pain Medicine and Harvard Medical School,
United States of America
| |
Collapse
|
23
|
Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr 2022; 10:954995. [PMID: 35928690 PMCID: PMC9343701 DOI: 10.3389/fped.2022.954995] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Burn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment. METHODS We performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021. RESULTS There were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0-18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1-5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as "limited" for 23% of pediatric patients. CONCLUSIONS Children represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.
Collapse
Affiliation(s)
- Kelly C Jordan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Jane L Di Gennaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Amélie von Saint André-von Arnim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
| |
Collapse
|
24
|
Surgical Safety Checklist: Polychromatic or Achromatic Design. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:11-16. [PMID: 34970728 DOI: 10.1007/5584_2021_699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Surgical Safety Checklist (SSC) has been created based on the recommendations of the WHO and obligatorily introduced worldwide. SSC is used to increase the patient's safety and reduce complications while in the hospital, especially in the perioperative period. The original SSC template was of a multicolor polychromatic design. However, an achromatic black-and-white or gray-gray design on plain printer paper appears often used in clinical practice. This review aims to assess the level of SSC use in the polychromatic versus achromatic versions and the pros and cons of using either in practice. We used the Google browser for the identification and collection of SSC graphic images available as of June 2021 using the following search commands: "surgical safety checklist WHO" or "surgical safety checklist" or "SSC WHO." The commands were repeated in 103 languages representing the five continents with the back answers provided in 41 languages. The successive top 10 thematically relevant images or fewer if not available in the cases of some foreign languages were considered for analysis, providing a mean of 5 ±2 images per language. The numbers of achromatic and polychromatic two-color or multicolor images were calculated. The number of images corresponding to the respective color designs ranged as follows: 0-6 (27.6%), 0-9 (41.6%), and 0-6 (27.6%) We conclude that polychromatic imaging of SSC documents predominates in practical use. The polychromatic SSC design catches the doctor's eye, which likely increases the effectiveness of completing the document.
Collapse
|
25
|
Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I. Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic. MEDICINES (BASEL, SWITZERLAND) 2021; 8:60. [PMID: 34677489 PMCID: PMC8541053 DOI: 10.3390/medicines8100060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. METHODS international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. RESULTS a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. CONCLUSIONS elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
Collapse
Affiliation(s)
- Attila Louis Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Kudrat Jumaniyazov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Shahnoza Yusupova
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Ruslan Jabbarov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Olimjon Saidmamatov
- Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan
| | - Ivanna Mayboroda-Major
- Department of Gynecology and Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland
| |
Collapse
|
26
|
Kalala B, Ferguson D, Nizeyimana F, Thakore S, Myukiyehe JP, Twagirumugabi T, Nyirigira G, Banguti P, O'Brien J, McKay W. A survey of pediatric postoperative pain management in Rwanda. Can J Anaesth 2021; 68:1718-1720. [PMID: 34350558 PMCID: PMC8336667 DOI: 10.1007/s12630-021-02082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Brigitte Kalala
- University of Rwanda, Kigali, Rwanda.,College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Francoise Nizeyimana
- University of Rwanda, Kigali, Rwanda.,College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Perioperative pediatric mortality in Ethiopia: A prospective cohort study. Ann Med Surg (Lond) 2021; 67:102396. [PMID: 34168866 PMCID: PMC8209180 DOI: 10.1016/j.amsu.2021.102396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background There was recording of excellent outcomes for pediatric surgery in developed countries of the world when it was carried out by an experienced pediatric surgeon and anesthetists with availabilities of equipment. However, this circumstance was not the ordinary for developing countries. The main objective of our study was to launch a pediatric perioperative mortality rate reference point and determination of associated factors under general or regional anesthesia in Ethiopia. Materials and methods the prospective electronic based data collection was done at Tibebe Ghion Specialized Teaching Hospital, Ethiopia with case specific of perioperative data for age less than 18 years old. We computed patients with mortality at 24 h, 48 h and 7 days in the form of percentages. Logistic regression was used for evaluation of mortality at different predictor variables. Results from 849 cases analyzed, there were mortality rate of 0.59%, 1.42%, and 2.58% within 24 h, 48 h and 7 days of surgery, respectively. The emergency surgeries (OR = 2.80 [95% CI, 1.78-3.82]; p < 0.03) were associated with an increased risk of mortality within 7 days of post-surgery. Conclusion Despite the progresses reached in the pediatric anesthesia and surgical safety in Tibebe Ghion Specialized Teaching Hospital, the pediatric perioperative mortality rates were still high or comparable to other low income African countries. Emergency surgeries were associated with an increased risk of perioperative mortality within 7 days of surgical intervention.Tibebe Ghion Specialized Teaching Hospital should emphasis on evaluation and monitoring of outcome for reduction of mortality with the emergency surgeries younger than 18 years old. We also suggested doing this research work at larger sample sizes for more actual information.
Collapse
|
28
|
Mihretu F. The current state of anesthesia safety in a third world country: a cross-sectional survey among anesthesia providers in Ethiopia. Patient Saf Surg 2021; 15:17. [PMID: 33882981 PMCID: PMC8059013 DOI: 10.1186/s13037-021-00290-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Improving patient safety during anesthesia and surgery becomes a major global public health issue due to the increasing in surgical burden. Anesthesia is delivered safely in developed countries, but its safety is hampered by complex problems in third world countries. This survey assesses the unmet anesthesia needs of one of a third world country, Ethiopia. METHODS A cross-sectional survey was conducted in Amhara region of Ethiopia from 15/12/2019 to 30/1/2020. All 81 hospitals of the region were stratified by their level as district, general, and referral hospital. The study was conducted in 66 hospitals. The number of hospitals from each strata were calculated by proportional sampling technique resulting; five referral, three general, and fifty eight primary hospitals. Each hospital from each strata was selected by convenience. Each anesthesia provider for the survey was selected randomly from each hospital and questionnaires were distributed. The minimum expected safe anesthesia requirements were taken from World Health Organization-World Federation of Societies of Anesthesiologists International Standard and Ethiopian Hospitals Standard. Anesthesia practice was expected safe if the minimum requirements were practiced always (100%) in each hospital. P < 0.05 with 95% confidence interval were used to compare the safety of anesthesia between higher and lower level hospitals. RESULTS Seventy eight (88.6%) anesthesia providers working in 62 hospitals responded to the survey. On aggregate, 36 (58%) hospitals from the total 62 hospitals have met the minimum expected safe anesthesia requirements. Among the different variables assessed; professional aspects 32 (52.45%), medication and intravenous fluid 33 (53.36%), equipment and facilities 33 (52.56%), patient monitoring 43(68.88%), and anesthesia conduct 38 (62.1%) of surveyed hospitals have met the minimum requirements. Anesthesia safety is relatively higher in higher level hospitals (general and referral) 6 (75%) when compared to district hospitals 30 (55.5%), P < 0.001. CONCLUSION Anesthesia safety in Ethiopia appears challenged by substandard continuous medical education and continuous professional development practice, and limited availability of some essential equipment and medications. Patient monitoring and anesthesia conduct are relatively good, but World Health Organization surgical safety checklist application and postoperative pain management are very low, affecting the delivery of safe anesthesia conduct.
Collapse
Affiliation(s)
- Fassil Mihretu
- Department of Anesthesia, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| |
Collapse
|
29
|
Sund G, Lipnick M, Law T, Wollner E, Rwibuka G. Anaesthesia facility evaluation : a Whatsapp survey of hospitals in Burundi. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.2.2456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
30
|
Lonnée HA, Taule K, Knoph Sandvand J, Koroma MM, Dumbuya A, Jusu KS, Shour MA, Duinen AJ. A survey of anaesthesia practices at all hospitals performing caesarean sections in Sierra Leone. Acta Anaesthesiol Scand 2021; 65:404-419. [PMID: 33169383 DOI: 10.1111/aas.13736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/07/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Providing safe anaesthesia is essential when performing caesarean sections, one of the most commonly performed types of surgery. Anaesthesia-related causes of maternal mortality are generally considered preventable. The primary aim of our study was to assess the type of anaesthesia used for caesarean sections in Sierra Leone. Secondary aims were to identify the type and training of anaesthesia providers, availability of equipment and drugs and use of perioperative routines. METHODS All hospitals in Sierra Leone performing caesarean sections were included. In each facility, one randomly selected anaesthesia provider was interviewed face-to-face using a predefined questionnaire. RESULTS In 2016, 36 hospitals performed caesarean sections in Sierra Leone. The most commonly used anaesthesia method for caesarean section was spinal anaesthesia (63%), followed by intravenous ketamine without intubation; however, there was a wide variety between hospitals. Of all anaesthesia providers, 33% were not qualified to provide anaesthesia independently, as stipulated by local regulations. Of those, 50% expressed high confidence in their skills to handle obstetric emergencies. There were discrepancies among hospitals in the availability of essential drugs, the use of post-operative recovery and the presence of a functioning blood bank. CONCLUSION Anaesthesia for caesarean sections in Sierra Leone showed a predominance for spinal anaesthesia. The workforce consisted mainly of non-physicians, of which a third was not trained to provide anaesthesia independently. Both the type of anaesthesia and the presence of qualified anaesthetic providers was widely variable between hospitals. Significant gaps were identified in the availability of equipment, essential drugs and perioperative routines.
Collapse
Affiliation(s)
- Herman A. Lonnée
- Department of Anaesthesia and Intensive Care St. Olav’s Hospital Trondheim Norway
| | - Katinka Taule
- Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | | | - Michael M. Koroma
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
- Department of Anaesthesia Princess Christian Maternity Hospital (PCMH) Freetown Sierra Leone
| | | | - Kakpama S.K. Jusu
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Mohamed A. Shour
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Alex J. Duinen
- Department of Cancer Research and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olav’s HospitalTrondheim University Hospital Trondheim Norway
| |
Collapse
|
31
|
Moll V, Mariano ER, Kitzman JM, O'Reilly-Shah VN, Jabaley CS. Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study. PLoS One 2021; 16:e0244860. [PMID: 33524031 PMCID: PMC7850494 DOI: 10.1371/journal.pone.0244860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.
Collapse
Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Edward R. Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Jamie M. Kitzman
- Department of Pediatric Anesthesiology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Vikas N. O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Craig S. Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| |
Collapse
|
32
|
Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Causes and Effects of Introducing Surgery Safety Checklist: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1335:53-62. [PMID: 33797735 DOI: 10.1007/5584_2021_631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The medical treatment process, particularly surgery, is inescapably bound to potential complications or undesirable adverse events. This narrative review aims to present the causes and effects of the introduction of the WHO Surgery Safety Checklist (SSC), the use of which is expected to reduce the number of perioperative errors, complications, and mortality. To achieve this objective, we performed a bibliometric analysis of medical citations indexed in the PubMed database using the SSC subject heading. Findings revealed a total of 1441 articles meeting inclusion status, with 1171 published during the last decade. After the screening of titles and abstracts, the members of the research team selected 75 articles, deemed most relevant for inclusion in the review, which were then thoroughly analyzed. All in all, the findings were that the use of SSC appreciably reduced the number of simple logistic errors in the perioperative period decreasing the frequency of resulting complications and mortality.
Collapse
Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczysław Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
| |
Collapse
|
33
|
White VE, Asfaw G, Moore JN. Anaesthesia practices for Caesarean section amongst non-physician anaesthesia providers at an Ethiopian referral hospital. Trop Doct 2020; 51:29-33. [PMID: 33251984 DOI: 10.1177/0049475520974991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sub-Saharan Africa faces high rates of maternal mortality and there is an urgent need to reduce this. Shortfalls in access to safe surgery and anaesthetic care result in avoidable maternal death. Providing quality training to anaesthesia providers is of key importance to reduce mortality. This mixed-methods prospective study incorporated workplace observations of anaesthesia for Caesarean section, a paper-based questionnaire and semi-structured, face-to-face interviews in Felege Hiwot Referral Hospital in Ethiopia.A total of 67 Caesarean section cases under spinal anaesthesia provided by 12 non-physician anaesthetists were observed and a 92% (n = 11) response rate to questionnaires obtained. Deficiencies were observed in communication, pre-operative assessment, spinal height evaluation and application of lateral tilt, while interviews revealed anaesthesia provider perceptions of hierarchy within the surgical team and deficiency in anticipation of potential complications. This study suggests that focusing on communication and anticipation of complications could aid providers in preventing and preparing for complications.
Collapse
Affiliation(s)
| | - Gebrehiwot Asfaw
- Lecturer, Department of Anaesthesia, 128158Bahir Dar University, Bahir Dar, Ethiopia
| | - Jolene Nina Moore
- Senior Clinical Lecturer, School of Medicine, Medical Sciences and Nutrition, 1019University of Aberdeen, Aberdeen, UK
| |
Collapse
|
34
|
Mechtenberg A, McLaughlin B, DiGaetano M, Awodele A, Omeeboh L, Etwalu E, Nanjula L, Musaazi M, Shrime M. Health care during electricity failure: The hidden costs. PLoS One 2020; 15:e0235760. [PMID: 33147212 PMCID: PMC7641375 DOI: 10.1371/journal.pone.0235760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background Surgery risks increase when electricity is accessible but unreliable. During unreliable electricity events and without data on increased risk to patients, medical professionals base their decisions on anecdotal experience. Decisions should be made based on a cost-benefit analysis, but no methodology exists to quantify these risks, the associated hidden costs, nor risk charts to compare alternatives. Methods Two methodologies were created to quantify these hidden costs. In the first methodology through research literature and/or measurements, the authors obtained and analyzed a year’s worth of hour-by-hour energy failures for four energy healthcare system (EHS) types in four regions (SolarPV in Iraq, Hydroelectric in Ghana, SolarPV+Wind in Bangladesh, and Grid+Diesel in Uganda). In the second methodology, additional patient risks were calculated according to time and duration of electricity failure and medical procedure impact type. Combining these methodologies, the cost from the Value of Statistical Lives lost divided by Energy shortage ($/kWh) is calculated for EHS type and region specifically. The authors define hidden costs due to electricity failure as VSL/E ($/kWh) and compare this to traditional electricity costs (always defined in $/kWh units), including Levelized Cost of Electricity (LCOE also in $/kWh). This is quantified into a fundamentally new energy healthcare system risk chart (EHS-Risk Chart) based on severity of event (probability of deaths) and likelihood of event (probability of electricity failure). Results VSL/E costs were found to be 10 to 10,000 times traditional electricity costs (electric utility or LCOE based). The single power source EHS types have higher risks than hybridized EHS types (especially as power loads increase over time), but all EHS types have additional risks to patients due to electricity failure (between 3 to 105 deaths per 1,000 patients). Conclusions These electricity failure risks and hidden healthcare costs can now be calculated and charted to make medical decisions based on a risk chart instead of anecdotal experience. This risk chart connects public health and electricity failure using this adaptable, scalable, and verifiable model.
Collapse
Affiliation(s)
- Abigail Mechtenberg
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
- * E-mail:
| | - Brady McLaughlin
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Michael DiGaetano
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Abigail Awodele
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Leslie Omeeboh
- Center for Sustainable Energy, University of Notre Dame, South Bend, Indiana, United States of America
- Department of Physics and Preprofessional Studies, College of Science, University of Notre Dame, South Bend, Indiana, United States of America
| | - Emmanuel Etwalu
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | | | - Moses Musaazi
- College of Engineering, Design, Art, and Technology (CEDAT), Makerere University, Kampala, Uganda
| | - Mark Shrime
- Harvard Medical School, Harvard University, Boston, MA, United States of America
| |
Collapse
|
35
|
Firth PG, Mai CL. The evolution of pediatric sedation and anesthesia patient safety: An interview with Dr Charles J. "Charlie" Coté. Paediatr Anaesth 2020; 30:1183-1190. [PMID: 33569801 DOI: 10.1111/pan.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
The career of Dr Charles J. Coté covered a period of major advances in pediatric anesthesia patient safety. Dr Coté (1946 --), Professor Emeritus in Anaesthesia at Harvard Medical School, helped develop pediatric sedation guidelines, conducted influential clinical research, edited a major textbook, and promoted pediatric anesthesia training fellowships in low- and middle-income countries. Based on a series of interviews with Dr Coté, this article reviews the career of this Robert M. Smith Award winner through the lens of improvements in pediatric sedation and anesthesia patient safety.
Collapse
Affiliation(s)
- Paul G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
36
|
Moll V, Schmidt PC, Amos C, Workneh RS, Tadesse M, Mulugeta E, Abate A. Building regional anesthesia capacity in limited-resource settings: a pilot study evaluating a 4-week curriculum. Pain Manag 2020; 11:29-37. [PMID: 33073715 DOI: 10.2217/pmt-2020-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To pilot a 4-week regional anesthesia curriculum for limited-resource settings. Intervention: A baseline needs assessment and knowledge test were deployed. The curriculum included lectures and hands-on teaching, followed by knowledge attainment tests. Results: Scores on the knowledge test improved from a mean of 37.1% (SD 14.7%) to 50.9% (SD 18.6%) (p = 0.017) at 4 weeks and 49% at 24 months. An average of 1.7 extremity blocks per month was performed in 3 months prior to the curriculum, compared with an average of 4.1 per month in 8 months following. Conclusion: This collaborative curriculum appeared to have a positive impact on the knowledge and utilization of regional anesthesia.
Collapse
Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA.,Institute of Anesthesiology, University of Zurich, Zurich, Switzerland
| | - Peter C Schmidt
- Department of Anesthesiology, Division of Pain Medicine, Stanford University, Stanford, CA, USA
| | - Corrie Amos
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY, USA
| | - Rediet S Workneh
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Mahelet Tadesse
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Ewnetu Mulugeta
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| |
Collapse
|
37
|
Tran QK, Mark NM, Losonczy LI, McCurdy MT, Lantry JH, Augustin ME, Colas LN, Skupski R, Toth AS, Patel BM, Zimmer DF, Tracy R, Walsh M. Using critical care physicians to deliver anesthesia and boost surgical caseload in austere environments: the Critical Care General Anesthesia Syllabus (CC GAS). Heliyon 2020; 6:e04142. [PMID: 32577558 PMCID: PMC7305384 DOI: 10.1016/j.heliyon.2020.e04142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 03/19/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Despite an often severe lack of surgeons and surgical equipment, the rate-limiting step in surgical care for the nearly five billion people living in resource-limited areas is frequently the absence of safe anesthesia. During disaster relief and surgical missions, critical care physicians (CCPs), who are already competent in complex airway and ventilator management, can help address the need for skilled anesthetists in these settings. Methods We provided a descriptive analysis that CCPs were trained to provide safe general anesthesia, monitored anesthesia care (MAC), and spinal anesthesia using a specifically designed and simple syllabus. Results Six CCPs provided anesthesia under the supervision of a board-certified anesthesiologist for 58 (32%) cases of a total of 183 surgical cases performed by a surgical mission team at St. Luc Hospital in Port-au-Prince, Haiti in 2013, 2017, and 2018. There were no reported complications. Conclusions Given CCPs' competencies in complex airway and ventilator management, a CCP, with minimal training from a simple syllabus, may be able to act as an anesthesiologist-extender and safely administer anesthesia in the austere environment, increasing the number of surgical cases that can be performed. Further studies are necessary to confirm our observation.
Collapse
Affiliation(s)
- Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Program of Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Natalie M Mark
- Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
| | - Lia I Losonczy
- Department of Emergency Medicine, The George Washington University Medical Center, Washington, DC, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James H Lantry
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Arthur S Toth
- Memorial Hospital Trauma Center, South Bend, IN, USA
| | - Bhavesh M Patel
- Department of Critical Care, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Rebecca Tracy
- Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
| | - Mark Walsh
- Memorial Hospital Trauma Center, South Bend, IN, USA
| |
Collapse
|
38
|
Tao KM, Sokha S, Yuan HB. The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia. BMC Health Serv Res 2020; 20:204. [PMID: 32164745 PMCID: PMC7068932 DOI: 10.1186/s12913-020-5068-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. Methods We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA. Results A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations. Conclusions This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.
Collapse
Affiliation(s)
- Kun-Ming Tao
- Department of Anesthesiology, Eastern Hepatobillary Surgical Hospital, Second Military Medical University, Shanghai, China
| | - Sann Sokha
- Department of Anesthesiology, Preah Ket Mealea Hospital, Phnom Penh, Cambodia
| | - Hong-Bin Yuan
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, P.R. China.
| |
Collapse
|
39
|
Abstract
Abstract
Background
The global surgery access imbalance will have a dramatic impact on the growing population of the world’s children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery–specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care. To establish a baseline pediatric perioperative mortality rate and factors associated with mortality in Kenya, the authors designed a prospective cohort study and measured 24-h, 48-h, and 7-day perioperative mortality.
Methods
The authors trained anesthesia providers to electronically collect 132 data elements for pediatric surgical cases in 24 government and nongovernment facilities at primary, secondary, and tertiary hospitals from January 2014 to December 2016. Data assistants tracked all patients to 7 days postoperative, even if they had been discharged. Adjusted analyses were performed to compare mortality among different hospital levels after adjusting for prespecified risk factors.
Results
Of 6,005 cases analyzed, there were 46 (0.8%) 24-h, 62 (1.1%) 48-h, and 77 (1.7%) 7-day cumulative mortalities reported. In the adjusted analysis, factors associated with a statistically significant increase in 7-day mortality were American Society of Anesthesiologists Physical Status of III or more, night or weekend surgery, and not having the Safe Surgery Checklist performed. The 7-day perioperative mortality rate is less in the secondary (1.4%) and tertiary (2.4%) hospitals when compared with the primary (3.7%) hospitals.
Conclusions
The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low–middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Collapse
|
40
|
Manyumwa P, Chimhundu-Sithole T, Marange-Chikuni D, Evans FM. Adaptations in pediatric anesthesia care and airway management in the resource-poor setting. Paediatr Anaesth 2020; 30:241-247. [PMID: 31910309 DOI: 10.1111/pan.13824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non-physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low-resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.
Collapse
Affiliation(s)
| | - Tsitsi Chimhundu-Sithole
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Danai Marange-Chikuni
- Department of Anesthesia and Critical Care Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, USA
| |
Collapse
|
41
|
|
42
|
Assessment of the current capacity of intensive care units in Uganda; A descriptive study. J Crit Care 2020; 55:95-99. [DOI: 10.1016/j.jcrc.2019.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022]
|
43
|
Mumbwe MC, McIsaac D, Jarman A, Bould MD. A Cross-Sectional Survey to Determine the Prevalence of Burnout Syndrome Among Anesthesia Providers in Zambian Hospitals. Anesth Analg 2020; 130:310-317. [PMID: 31725020 DOI: 10.1213/ane.0000000000004464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Burnout is a psychological syndrome that results from chronic exposure to job stress. It is defined by a triad of emotional exhaustion, depersonalization, and reduced personal accomplishment. In research, mostly from high-income countries, burnout is common in health care professionals, especially in anesthesiologists. Burnout can negatively impact patient safety, the physical and mental health of the anesthetist, and institutional efficiency. However, data on burnout for anesthesia providers in low- and middle-income countries are poorly described. This study sought to determine the prevalence of burnout syndrome among all anesthesia providers (physician and nonphysician) working in Zambian hospitals and to determine which sociodemographic and occupational factors were associated with burnout. METHODS A questionnaire was sent to all Zambian anesthesia providers working in private and public hospitals. The questionnaire assessed burnout using the Maslach Burnout Inventory Human Services Survey, a validated 22-item survey widely used to measure burnout among health professionals. Sociodemographic and occupational factors postulated to be associated with burnout were also assessed. RESULTS Surveys were distributed to all 184 anesthesia providers in Zambia; 160 were returned. This resulted in a response rate representing 87% of all anesthesia providers in the country. Eighty-six percentage of respondents were nonphysician anesthesia providers. Burnout was present in 51.3% (95% confidence interval [CI], 43.2-59.2) of participants. Logistic regression analysis revealed that "not having the right team to carry out work to an appropriate standard" (odds ratio, 2.91, 95% CI, 1.33-6.39; P = .008), and "being a nonphysician" (odds ratio, 3.4, 95% CI, 1.25-12.34; P = .019) were significantly associated with burnout in this population. CONCLUSIONS In a cross-sectional survey of anesthesia providers in Zambia, >50% of the respondents met the criteria for burnout. The risk was particularly high among nonphysician providers who typically work in isolated rural practice. Efforts to decrease burnout rates through policy and educational initiatives to increase the quantity and quality of training for anesthesia providers should be considered.
Collapse
Affiliation(s)
- Mbangu C Mumbwe
- From the Department of Anesthesia, University Teaching Hospital, Lusaka, Ministry of Health, Zambia
| | - Dan McIsaac
- Department of Anesthesiology & Pain Medicine and Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alison Jarman
- Department of Anaesthesia, Austin Hospital, Melbourne, Australia
| | - M Dylan Bould
- Department of Anesthesia and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| |
Collapse
|
44
|
Mossenson AI, Tuyishime E, Rawson D, Mukwesi C, Whynot S, Mackinnon SP, Livingston P. Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting. Br J Anaesth 2020; 124:206-213. [DOI: 10.1016/j.bja.2019.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/05/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022] Open
|
45
|
Law TJ, Lipnick M, Joshi M, Rath GP, Gelb AW. The path to safe and accessible anaesthesia care. Indian J Anaesth 2019; 63:965-971. [PMID: 31879420 PMCID: PMC6921309 DOI: 10.4103/ija.ija_756_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
The increasing focus on and importance of surgical care in achieving universal health coverage requires the development of safe and accessible anaesthesia services. Increasing access to care by supporting the necessary inputs to the anaesthesia system, including medications, equipment and personnel, must be accompanied by processes that support high-quality care, including support for education, and guidelines for standards, and training. As safe, high-quality care requires an integrated approach, each element must be supported together, i.e., in an integrated manner to ensure that anaesthesia care reaches those who need it, and in the safest possible manner. Several important efforts have been undertaken globally to address and foster these elements, and resources to guide these processes exist for low- and middle-income countries to improve them. This review highlights both the needs and resources for safe and high-quality care that patients deserve.
Collapse
Affiliation(s)
- Tyler J Law
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Michael Lipnick
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | - Muralidhar Joshi
- Department of Anesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Girija P Rath
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Adrian W Gelb
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| |
Collapse
|
46
|
Ragazzoni L, Kwizera A, Caviglia M, Bodas M, Franc JM, Ssemmanda H, Ripoll-Gallardo A, Della-Corte F, Alenyo-Ngabirano A. Intra-operative low-dose ketamine does not reduce the cost of post-operative pain management after surgery: a randomized controlled trial in a low-income country. Afr Health Sci 2019; 19:3127-3135. [PMID: 32127889 PMCID: PMC7040337 DOI: 10.4314/ahs.v19i4.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings. OBJECTIVES The aim of this study was to explore the overall reduction in the medication treatment cost of acute post-operative pain by adding intra-operative low-dose ketamine to traditional intravenous morphine for surgery in a low-income country. METHODS A double blind randomized controlled trial with placebo-controlled parallel group was performed in Mulago National Hospital (Uganda). Consenting adults scheduled for elective surgery were randomized into two study arms: Group K received ketamine 0.15mg/kg bolus at induction and a continuous infusion of 0.12 mg/kg/hour till start of skin closure; Group C (control) received normal saline. Both groups received Morphine 0.1 mg/kg IV at debulking. The total medication cost was registered. NRS pain scores and other measurements such vital signs and incidence of major and minor side effects were also recorded. RESULTS A total of 46 patients were included. Patients' baseline characteristics were comparable in both groups. No statistically significant difference was found between the groups concerning the overall medication cost of post-operative pain management. Pain scores, patients' satisfaction in the first 24 hours after surgery and hospital length of stay were similar in both groups. CONCLUSION Our results do not support the utilization of intra-operative low dose ketamine as a cost-saving post-operative pain treatment strategy for all types of surgery in low-resource settings.
Collapse
Affiliation(s)
- Luca Ragazzoni
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Arthur Kwizera
- Department of Anaesthesia, Makerere University, Kampala, Uganda
| | - Marta Caviglia
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Moran Bodas
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Jeffrey Michael Franc
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Alba Ripoll-Gallardo
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Francesco Della-Corte
- CRIMEDIM — Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | | |
Collapse
|
47
|
Ooms GI, Klatser P, van den Ham HA, Reed T. Barriers to Accessing Internationally Controlled Essential Medicines in Uganda: A Qualitative Study. J Pain Symptom Manage 2019; 58:835-843.e1. [PMID: 31302261 DOI: 10.1016/j.jpainsymman.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Access to internationally controlled essential medicines is a problem worldwide. More than five billion people cannot access opioids for pain and palliative care or do not have access to surgical care or anesthetics, 25 million people living with epilepsy do not have access to their medicines, and 120,000 women die annually owing to postpartum hemorrhage. In Uganda, access to controlled medicines is also problematic, but a lack of data on factors that influence access exists. OBJECTIVES The objective of this study was to identify the social, cultural, and regulatory barriers that influence access to internationally controlled essential medicines in Uganda. METHODS Semistructured interviews with 15 key stakeholders with knowledge on controlled medicines from relevant institutions in Uganda. Interviews were transcribed verbatim and analyzed using the Access to Medicines from a Health System Perspective framework. RESULTS Barriers in accessing controlled medicines were experienced owing to lack of prioritization, difficulties in finding the balance between access and control, deficiencies in the workings of the estimate and distribution system, lack of knowledge, inadequate human resources, expenses related to use and access, and stigma. It was believed that some abuse of specific controlled medicines occurred. CONCLUSION The findings of this research indicate that to improve access to internationally controlled essential medicines in Uganda, health system strengthening is needed on multiple fronts. Active engagement and concerted efforts are needed from all stakeholders to ensure access and prevent abuse.
Collapse
Affiliation(s)
- Gaby Isabelle Ooms
- Health Action International, Amsterdam, The Netherlands; WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| | | | - Hendrika A van den Ham
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, The Netherlands
| |
Collapse
|
48
|
Law TJ, Bulamba F, Ochieng JP, Edgcombe H, Thwaites V, Hewitt-Smith A, Zoumenou E, Lilaonitkul M, Gelb AW, Workneh RS, Banguti PM, Bould D, Rod P, Rowles J, Lobo F, Lipnick MS. Anesthesia Provider Training and Practice Models: A Survey of Africa. Anesth Analg 2019; 129:839-846. [PMID: 31425228 DOI: 10.1213/ane.0000000000004302] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. METHODS Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. RESULTS One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). CONCLUSIONS Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts.
Collapse
Affiliation(s)
- Tyler J Law
- From the Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Fred Bulamba
- Department of Anesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - John Paul Ochieng
- Department of Anesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Hilary Edgcombe
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Victoria Thwaites
- Department of Anesthesia, Inverclyde Royal Hospital, Glasgow, United Kingdom
| | - Adam Hewitt-Smith
- Department of Anesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | - Maytinee Lilaonitkul
- From the Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Adrian W Gelb
- From the Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Rediet S Workneh
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Paulin M Banguti
- Department of Anesthesia, Critical Care and Emergency Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Dylan Bould
- Department of Anesthesia and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Pascal Rod
- International Federation of Nurse Anesthetists, Mantes la Jolie, France
| | - Jackie Rowles
- School of Nurse Anesthesia, Texas Christian University, Fort Worth, Texas
| | - Francisco Lobo
- Anesthesiology Department, Centro Hospitalar do Porto, Porto, Portugal
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Michael S Lipnick
- From the Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| |
Collapse
|
49
|
Abstract
PURPOSE OF REVIEW Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present. RECENT FINDINGS AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.
Collapse
|
50
|
Boyd N, Sharkey E, Nabukenya M, Tumukunde J, Sipuka N, Zyambo M, Walker I, Hart J, Byrne-Davis L. The Safer Anaesthesia from Education (SAFE) ® paediatric anaesthesia course: educational impact in five countries in East and Central Africa. Anaesthesia 2019; 74:1290-1297. [PMID: 31350856 DOI: 10.1111/anae.14778] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2019] [Indexed: 11/28/2022]
Abstract
There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.
Collapse
Affiliation(s)
- N Boyd
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - E Sharkey
- Department of Anaesthesia, University College Hospital, London, UK
| | - M Nabukenya
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - J Tumukunde
- Department of Anaesthesia, Makerere University College of Health Sciences, Kampala, Uganda
| | - N Sipuka
- Department of Anaesthesia and Critical Care, University Teaching Hospital, Lusaka, Zambia
| | - M Zyambo
- Department of Anaesthesia and Critical Care, University Teaching Hospital, Lusaka, Zambia
| | - I Walker
- Department of Anaesthesia, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Department of Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Hart
- Department of Education, University of Manchester, Manchester, UK
| | - L Byrne-Davis
- Department of Education, University of Manchester, Manchester, UK
| |
Collapse
|