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Schifino Wolmeister A, Hansen TG, Engelhardt T. Challenges of organizing pediatric anesthesia in low and middle-income countries. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844525. [PMID: 38906364 PMCID: PMC11276913 DOI: 10.1016/j.bjane.2024.844525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Anelise Schifino Wolmeister
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada; Hospital de Clínicas de Porto Alegre, Departamento de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil.
| | - Tom G Hansen
- Akershus University Hospital, Department of Anesthesia & Intensive Care, Lørenskog, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Thomas Engelhardt
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada
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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [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: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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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).
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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
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Tiradentes TAA, Einav S, Braz JRC, Nunes-Nogueira VS, Betini M, Corrente JE, Braz MG, Braz LG. Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis. Br J Anaesth 2023; 131:901-913. [PMID: 37743151 DOI: 10.1016/j.bja.2023.08.023] [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: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Neonates and infants have a higher perioperative risk of cardiac arrest and mortality than adults. The Human Development Index (HDI) ranges from 0 to 1, representing the lowest and highest levels of development, respectively. The relation between anaesthesia safety and country HDI has been described previously. We examined the relationship among the anaesthesia-related cardiac arrest rate (ARCAR), country HDI, and time in a mixed paediatric patient population. METHODS Electronic databases were searched up to July 2022 for studies reporting 24-h postoperative ARCARs in children. ARCARs (per 10,000 anaesthetic procedures) were analysed in low-HDI (HDI<0.8) vs high-HDI countries (HDI≥0.8) and over time (pre-2001 vs 2001-22). The magnitude of these associations was studied using systematic review methods with meta-regression analysis and meta-analysis. RESULTS We included 38 studies with 5,493,489 anaesthetic procedures and 1001 anaesthesia-related cardiac arrests. ARCARs were inversely correlated with country HDI (P<0.0001) but were not correlated with time (P=0.82). ARCARs did not change between the periods in either high-HDI or low-HDI countries (P=0.71 and P=0.62, respectively), but were higher in low-HDI countries than in high-HDI countries (9.6 vs 2.0; P<0.0001) in 2001-22. ARCARs were higher in children aged <1 yr than in those ≥1 yr in high-HDI (10.69 vs 1.48; odds ratio [OR] 8.03, 95% confidence interval [CI] 5.96-10.81; P<0.0001) and low-HDI countries (36.02 vs 2.86; OR 7.32, 95% CI 3.48-15.39; P<0.0001) in 2001-22. CONCLUSIONS The high and alarming anaesthesia-related cardiac arrest rates among children younger than 1 yr of age in high-HDI and low-HDI countries, respectively, reflect an ongoing challenge for anaesthesiologists. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42021229919.
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Affiliation(s)
- Teofilo Augusto A Tiradentes
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jose R C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Vania S Nunes-Nogueira
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Marluci Betini
- Technical Division of Library and Documentation, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Mariana G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil.
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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
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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
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