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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.
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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
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