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Wollner EA, Nourian MM, Bertille KK, Wake PB, Lipnick MS, Whitaker DK. Capnography-An Essential Monitor, Everywhere: A Narrative Review. Anesth Analg 2023; 137:934-942. [PMID: 37862392 DOI: 10.1213/ane.0000000000006689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.
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Affiliation(s)
- Elliot A Wollner
- From the Department of Anaesthesia and Perioperative Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ki K Bertille
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Pauline B Wake
- School of Medicine and Health Sciences, University of Papua New Guinea
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Medicine, Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - David K Whitaker
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, United Kingdom
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2
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Nemomssa HD, Raj H. Evaluation of a New Smartphone Powered Low-cost Pulse Oximeter Device. Ethiop J Health Sci 2022; 32:841-848. [PMID: 35950062 PMCID: PMC9341018 DOI: 10.4314/ejhs.v32i4.22] [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: 03/18/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Measurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter. Methods The new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method. Results The average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range. Conclusion The new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care.
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Affiliation(s)
- Hundessa Daba Nemomssa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
| | - Hakkins Raj
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Oromia, Ethiopia
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3
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Instructions for a Highly Relevant Tool in Line With the United Nations Goals for Sustainable Development. Anesth Analg 2021; 133:1129-1131. [PMID: 34437312 DOI: 10.1213/ane.0000000000005728] [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]
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4
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Burgess J, Asfaw G, Moore J. Adverse events during anaesthesia at an Ethiopian referral hospital: a prospective observational study. Pan Afr Med J 2021; 38:375. [PMID: 34367454 PMCID: PMC8308963 DOI: 10.11604/pamj.2021.38.375.24711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 04/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction incident reporting systems are widely utilised within healthcare to analyse adverse events and have been shown to reduce patient harm. With data to suggest high anaesthetic-related mortality in low and middle-income countries (LMICs), such systems could allow more accurate determination of rates and types of incidents and could improve patient safety. Methods this prospective observational study carried out over six-weeks in March to April 2019 in an Ethiopian tertiary referral hospital, included direct observations in the operating room and recording of any anaesthesia-related adverse events occurring during the perioperative period. Results fifty surgical cases were observed during weekday daytime hours. Sixteen anaesthesia-related adverse events were observed in 12 patients, including six elective cases and six emergencies, an adverse event rate of 32% (n=16), affecting 24% (n=12) of patients. Most incidents occurred in infants less than one-year-old and those between 11-20 years (31.3%; n=5 each) and those undergoing general anaesthesia (66.7%; n=8), particularly during the induction phase (50%; n=8), the most common event being prolonged desaturation (31.3%; n=5). Most events were considered to contribute a low level of harm (56.3%; n=9). There were no intra-operative mortalities. Conclusion this study presents evidence of a higher rate of adverse events during anaesthesia at a tertiary referral hospital in Ethiopia, than reported in current literature from LMICs. There is potential for large volume data to be produced and learnt from with a reporting system in place in this setting. The most common event was desaturation detected by pulse oximetry, particularly in paediatric surgery.
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Affiliation(s)
- Joe Burgess
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
| | - Gebrehiwot Asfaw
- Department of Anaesthesia, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jolene Moore
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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5
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Blaise Pascal FN, Malisawa A, Barratt-Due A, Namboya F, Pollach G. General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo. BMC Anesthesiol 2021; 21:60. [PMID: 33622245 PMCID: PMC7901086 DOI: 10.1186/s12871-021-01280-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Background General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo in the Democratic Republic of the Congo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods This was a retrospective descriptive and analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients files, anaesthesia registries and were analysed with SPSS 26. Results From a total of 921 patients, 539 (58.5%) were male and 382 (41.5%) female patients. A total of 83 (9.0%) patients died representing an overall perioperative mortality rate of 90 per 1000. Out of the 83 deaths, 38 occurred within 24 h representing GA related mortality of 41 per 1000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were: being a neonate or a senior adult, emergency operation, ASA physical status > 2 and a single deranged vital sign preoperatively, presenting any complication during GA, anaesthesia duration > 120 minutes as well as visceral surgeries/laparotomies. Ketamine was the most employed anaesthetic. Conclusion GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, improved infrastructure, better equipment and drugs procurement and considering regional anaesthesia whenever possible.
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Affiliation(s)
- Furaha Nzanzu Blaise Pascal
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi. .,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Agnes Malisawa
- Matanda Hospital of Butembo, Butembo, Democratic Republic of the Congo
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Felix Namboya
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gregor Pollach
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
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6
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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.
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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
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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.
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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
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8
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Dohlman LE, Kwikiriza A, Ehie O. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings. Local Reg Anesth 2020; 13:147-158. [PMID: 33122941 PMCID: PMC7588832 DOI: 10.2147/lra.s236550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023] Open
Abstract
Safe and accessible surgical and anesthetic care is critically limited for over half of the world's population, particularly in Sub-Saharan African and Southeast Asian countries. Increasing the use of regional anesthesia in these areas has potential benefits regarding access, safety, and cost-effectiveness. Perioperative anesthesia-related mortality is significantly higher in resource-limited countries and every effort should be made to encourage the use of anesthetic techniques in these countries that are safest under the present conditions. Studies from Sub-Saharan Africa, although limited in number, have shown a lower risk of death with regional compared to general anesthesia. Regional anesthesia has the further benefit of decreasing the risk of COVID-19 spread to healthcare providers by avoiding the aerosol-generating procedures that occur during general anesthesia. Neuraxial regional anesthesia is relatively easy to teach and perform and is considered the anesthetic of choice for surgeries below the umbilicus in resource-limited settings due to its safety, efficacy, and low cost. Although regional anesthesia has multiple potential advantages, education and training of anesthetic providers in low-and-middle-income countries (LMIC) are a significant barrier to growth. Anesthesia professionals, especially in Sub-Saharan Africa, are often poorly supported and undervalued, and recruitment and retention of adequate numbers of trained practitioners are a continuing problem. Greater use of regional anesthesia could be one way to safely increase anesthesia access and simultaneously create value and enthusiasm for the field. Deficits in anesthesia infrastructure, equipment, and drugs also limit anesthesia capacity in low-and middle-income countries. Ultrasound-guided regional anesthesia may be helpful in improving access to safe and reliable anesthesia in low-resource countries as it continues to become more user-friendly, durable, and affordable.
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Affiliation(s)
- Lena Ebba Dohlman
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Kwikiriza
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Odinakachukwu Ehie
- Department of Anesthesiology and Perioperative Services, University of California San Francisco, San Francisco, CA, USA
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9
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Moore JN, Morriss WW, Asfaw G, Tesfaye G, Ahmed AR, Walker IA. The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study. Anaesth Intensive Care 2020; 48:297-305. [PMID: 32830542 DOI: 10.1177/0310057x20940330] [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: 11/17/2022]
Abstract
SummaryReducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia.We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018.Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline (n = 101, 69% response rate). Pre- and post-course MCQs (n = 121, n = 123 respectively) and pre- and post-course skills tests (n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up (n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training (P < 0.0001) and skills test scores improved from 56.5% to 83.2% (P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3-11 months post-training compared to baseline (P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up.This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.
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Affiliation(s)
- Jolene N Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK.,School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Wayne W Morriss
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Department of Anaesthesia, University of Otago, Otago, New Zealand
| | | | - Gosa Tesfaye
- World Federation of Societies of Anaesthesiologists, London, UK
| | - Aaliya R Ahmed
- Department of Anaesthesia, University of Otago, Otago, New Zealand
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10
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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.
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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
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11
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Wollner E, Nourian MM, Booth W, Conover S, Law T, Lilaonitkul M, Gelb AW, Lipnick MS. Impact of capnography on patient safety in high- and low-income settings: a scoping review. Br J Anaesth 2020; 125:e88-e103. [PMID: 32416994 DOI: 10.1016/j.bja.2020.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Capnography is universally accepted as an essential patient safety monitor in high-income countries (HICs) yet is often unavailable in low and middle-income countries (LMICs). Increasing capnography availability has been proposed as one of many potential approaches to improving perioperative outcomes in LMICs. This scoping review summarises the existing literature on the effect of capnography on patient outcomes to help prioritise interventions and guide expansion of capnography in LMICs. METHODS We searched MEDLINE and EMBASE databases for articles published between 1980 and March 2019. Studies that assessed the impact of capnography on morbidity, mortality, or the use of airway interventions both inside and outside the operating room were included. RESULTS The search resulted in 7445 unique papers, and 31 were included for analysis. Retrospective and non-randomised data suggest capnography use may improve outcomes in the operating room, ICU, and emergency department, and during resuscitation. Prospective data on capnography use for procedural sedation suggest earlier detection of hypoventilation and a reduction in haemoglobin desaturation events. No randomised studies exist that assess the impact of capnography on patient outcomes. CONCLUSION Despite widespread endorsement of capnography as a mandatory perioperative monitor, rigorous data demonstrating its impact on patient outcomes are limited, especially in LMICs. The association between capnography use and a reduction in serious airway complications suggests that closing the capnography gap in LMICs may represent a significant opportunity to improve patient safety. Additional data are needed to quantify the global capnography gap and better understand the barriers to capnography scale-up in LMICs.
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Affiliation(s)
- Elliot Wollner
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
| | - Maziar M Nourian
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Booth
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Sophia Conover
- Medical Libraries, University of California San Francisco, San Francisco, CA, USA
| | - Tyler Law
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Maytinee Lilaonitkul
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Adrian W Gelb
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Lipnick
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
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12
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Chong HP, Quinn L, Cooksey R, Molony D, Jeeves A, Lodge M, Carney B. Mortality in paediatric burns at the Women's and Children's Hospital (WCH), Adelaide, South Australia: 1960-2017. Burns 2019; 46:207-212. [PMID: 31787476 DOI: 10.1016/j.burns.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Burn injuries are the third leading cause of preventable death in children worldwide, resulting in over 100 000 annual hospitalisations. In the paediatric population, scalds are the commonest mechanism and burn injuries of greater than 40% total burn surface area (TBSA) are associated with a high mortality and morbidity rate. AIMS The aim of this study was to review mortality in paediatric burns in a tertiary burns centre over a 60-year period, providing an understanding of local causes of mortality and directing future clinical research. METHODS We reviewed data collected prospectively from patients treated for burn injuries at the WCH from 1960 to 2017. Data of age, gender, mechanism of injury and TBSA were collected. TBSA of 40% and greater were included in the study. RESULTS All patients with total burn surface area (TBSA) less than 40% survived. There were a total of 75 patients who sustained burns of or greater than 40% TBSA. Overall mortality was 34% (26 of 75) of which 24 occurred in the 1960s. Of the 21 patients who died of flame burn injuries, 12 of them were described as clothes catching alight from being in close proximity to the source of flame. Average length of stay for patients who did not survive was 7 days (1-26). CONCLUSION Mortality has since declined and the prognosis for survival good, even in TBSA of greater than 90%. The investigations in fabric flammability led by Dr Thomas Pressley and Mr Murray Clarke prompted the rewriting of Australian standards for production of children's clothing. This, in combination with advances in paediatric resuscitation, surgical techniques as well as wound care has improved survival rates and outcomes in extensive burn injuries. Future studies focus to see not only better survival rates, but also better aesthetic and functional outcomes in burn survivors.
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Affiliation(s)
- Hsu Phie Chong
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia.
| | - Linda Quinn
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Rebecca Cooksey
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Darren Molony
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Amy Jeeves
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Michelle Lodge
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Bernard Carney
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
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13
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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.
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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
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Banguti PR, Mvukiyehe JP, Durieux ME. The World Health Organization Surgical Safety Checklist: Happy 10th Birthday! Anesth Analg 2019; 127:1283-1284. [PMID: 30433916 DOI: 10.1213/ane.0000000000003732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paulin R Banguti
- From the Department of Anesthesiology, University of Rwanda, Kigali, Rwanda
| | | | - Marcel E Durieux
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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15
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Lou-Meda R, Méndez S, Calgua E, Orozco M, Hall BJ, Fahsen N, Taicher BM, Doty JP, Colindres JG, Menegazzo CS, Rice HE. Developing a national patient safety plan in Guatemala. Rev Panam Salud Publica 2019; 43:e64. [PMID: 31410088 PMCID: PMC6668660 DOI: 10.26633/rpsp.2019.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022] Open
Abstract
Objective. Patient safety is challenging for health systems around the world, particularly in low-and middleincome countries such as Guatemala. The goal of this report is to summarize a strategic planning process for a national patient safety plan in Guatemala. Methods. This strategic planning process involved multiple stakeholders, including representatives of the Guatemala Ministry of Health and Social Assistance, medical leadership from across the public health system, and academic experts from Guatemala and the United States of America. We used mixed methods (quantitative and qualitative surveys) and a nominal group technique at a national symposium to prioritize patient safety challenges across Guatemala, and subsequent meetings to develop a national patient safety plan. Results. This national patient safety plan outlines four domains to advance patient safety across the public hospital system over a five-year period in Guatemala: leadership and governance, training and awareness, safety culture, and outcome metrics. For each domain, we developed a set of goals, activities, outputs, and benchmarks to be overseen by the Ministry of Health. Conclusions. With this national patient safety plan, Guatemala has made a long-term commitment to improving patient safety across the public hospital system of Guatemala. Future efforts will require its extension to all levels of the Guatemalan health system.
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Affiliation(s)
- Randall Lou-Meda
- Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital Guatemala CityGuatemala Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital, Guatemala City, Guatemala
| | - Sindy Méndez
- Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital Guatemala CityGuatemala Pediatric Nephrology Unit/Fundanier, Roosevelt Hospital, Guatemala City, Guatemala
| | - Erwin Calgua
- University of San Carlos of Guatemala University of San Carlos of Guatemala Guatemala CityGuatemala University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Mónica Orozco
- University of San Carlos of Guatemala University of San Carlos of Guatemala Guatemala CityGuatemala University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Bria J Hall
- Duke Global Health Institute Duke Global Health Institute DurhamNorth Carolina United States of America Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Natalie Fahsen
- FUNDEGUA FUNDEGUA Guatemala CityGuatemala FUNDEGUA, Guatemala City, Guatemala
| | - Brad M Taicher
- Duke Global Health Institute Duke Global Health Institute DurhamNorth Carolina United States of America Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joseph P Doty
- Department of Orthopedics Department of Orthopedics Duke University Medical Center DurhamNorth Carolina United States of America Department of Orthopedics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Julio García Colindres
- Guatemala Ministry of Public Health and Social Assistance Guatemala Ministry of Public Health and Social Assistance Guatemala CityGuatemala Guatemala Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Carlos Soto Menegazzo
- Guatemala Ministry of Public Health and Social Assistance Guatemala Ministry of Public Health and Social Assistance Guatemala CityGuatemala Guatemala Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Henry E Rice
- Duke Global Health Institute Duke Global Health Institute DurhamNorth Carolina United States of America Duke Global Health Institute, Durham, North Carolina, United States of America
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16
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Ho M, Livingston P, Bould MD, Nyandwi JD, Nizeyimana F, Uwineza JB, Urquart R. Barriers and facilitators to implementing a regional anesthesia service in a low-income country: a qualitative study. Pan Afr Med J 2019; 32:152. [PMID: 31303923 PMCID: PMC6607318 DOI: 10.11604/pamj.2019.32.152.17246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/29/2019] [Indexed: 01/17/2023] Open
Abstract
Introduction Regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. Methods Following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the “Consolidated Framework for Implementation Research” (CFIR). Data were coded using an inductive approach to discover emergent themes. Results Four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. Conclusion While the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.
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Affiliation(s)
- Matthew Ho
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Patricia Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - M Dylan Bould
- Department of Anesthesiology, University of Ottawa, Ontario, Canada
| | - Jean Damascène Nyandwi
- Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
| | - Françoise Nizeyimana
- Department of Anesthesiology and Intensive Care Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Robin Urquart
- Department of Surgery, Dalhousie University, Halifax, Canada
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Johnston BE, Lou-Meda R, Mendez S, Frush K, Milne J, Fitzgerald T, Sexton JB, Rice H. Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship. BMJ Glob Health 2019; 4:e001220. [PMID: 30899564 PMCID: PMC6407551 DOI: 10.1136/bmjgh-2018-001220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/27/2018] [Accepted: 01/19/2019] [Indexed: 11/23/2022] Open
Abstract
Health systems in low-income and middle-income countries (LMICs) have a high burden of medical errors and complications, and the training of local experts in patient safety is critical to improve the quality of global healthcare. This analysis explores our experience with the Duke Global Health Patient Safety Fellowship, which is designed to train clinicians from LMICs in patient safety, quality improvement and infection control. This intensive fellowship of 3-4 weeks includes (1) didactic training in patient safety and quality improvement, (2) experiential training in patient safety operations, and (3) mentorship of fellows in their home institution as they lead local safety programmes. We have learnt several lessons from this programme, including the need to contextualise training to local needs and resources, and to focus training on building interdisciplinary patient safety teams. Implementation challenges include a lack of resources and data collection systems, and limited recognition of the role of safety in global health contexts. This report can serve as an operational guide for intensive training in patient safety that is contextualised to global health challenges.
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Affiliation(s)
- Bria E Johnston
- Surgery and Global Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Randall Lou-Meda
- Pediatric Nephrology Unit, Hospital Roosevelt de Guatemala, Guatemala, Guatemala
| | - Sindy Mendez
- Pediatric Nephrology Unit, Hospital Roosevelt de Guatemala, Guatemala, Guatemala
| | - Karen Frush
- Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Judy Milne
- Patient Safety Office, Duke University Medical Center, Durham, North Carolina, USA
| | - Tamara Fitzgerald
- Pediatric Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - J Bryan Sexton
- Patient Safety Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Henry Rice
- Surgery and Global Health, Duke University Medical Center, Durham, North Carolina, USA
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18
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Bashford T, Vercueil A. Anaesthetic research in low- and middle-income countries. Anaesthesia 2018; 74:143-146. [PMID: 30525200 PMCID: PMC6587512 DOI: 10.1111/anae.14518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- T Bashford
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - A Vercueil
- Departments of Intensive Care Medicine and Anaesthesia, King's College Hospital NHS Trust, London, UK
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19
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Tabiri S, Russell KW, Gyamfi FE, Jalali A, Price RR, Katz MG. Local anesthesia underutilized for inguinal hernia repair in northern Ghana. PLoS One 2018; 13:e0206465. [PMID: 30462684 PMCID: PMC6248905 DOI: 10.1371/journal.pone.0206465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Inguinal hernia repair is a common procedure and a priority for public health efforts in Ghana. It is essential that inguinal hernia repair be performed in a safe, efficient manner to justify its widespread use. Local anesthesia has many favorable properties and has been shown to be superior, compared to regional or general anesthesia, in terms of pain control, safety profile, cost-effectiveness, resources required, and time to discharge. Local anesthesia is recommended for open repair of reducible hernias, provided clinician experience, by multiple international guidelines. Regional anesthesia is associated with myocardial infarction and other complications, and its use is discouraged by multiple guidelines, especially in older patients. This study aims to assess the current state of anesthesia for inguinal hernia repair in the northern and transitional zone of Ghana. In addition we will assess the perceptions of different types of anesthesia along with understanding of evidence-based guidelines among clinicians participating in inguinal hernia repair. Methods We performed a retrospective review of all inguinal hernia repairs for male patients, 18 and older, in over 90% of hospitals in northern Ghana. All 41 hospitals were visited and caselogs and patient charts were manually reviewed to extract data. Multivariate logistic regression was used to determine predictors of local anesthesia use. We designed a survey instrument to assess the perceptions of physicians and anesthetists regarding different types of anesthesia for inguinal hernia repair. The survey was designed by a Ghanaian surgeon, reviewed by all co-authors, and tested prior to implementation using a sample (n = 8) of clinicians having similar practices to those of the survey population. Of 70 clinicians, 66 responded, yielding a response rate of 94%. Results 8080 patients underwent hernia repair of which 37% were performed under local anesthesia, while the majority, 60%, were performed under regional anesthesia. Negative predictors of local anesthesia were emergent repair (OR = 0.258, p < 0.001), surgery performed at a teaching hospital (OR = 0.105, p < 0.001), and bilateral hernia repair (OR = 0.374, p < 0.001). 1,839 (22.8%) of IH repairs were done on patients age 65 or older and RA was most frequently used among the elderly population (57.8%), while local anesthesia was used 39.5% of the time. Sixty-six clinicians participated in the survey with the majority reporting that local anesthesia requires fewer staff, less equipment, has a shorter recovery, is more cost-effective, and might be safer for patients. However 66% were unfamiliar with or incorrectly perceived international guidelines. Conclusion To our knowledge, this study is the largest assessment of anesthesia use for inguinal hernia repair in an LMIC. Although the selection of anesthetic technique should be guided by a patient’s general health, the anatomy of the hernia, and clinician judgment, local anesthesia appears to be underutilized in northern Ghana. Survey responses demonstrate high rates of unfamiliarity or incorrectly perceived evidence-based guidelines. Future research should assess how education on the benefits and technique of local anesthesia administration may further increase rates for inguinal hernia repair, especially for older patients.
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Affiliation(s)
- Stephen Tabiri
- School of Medicine and Health Sciences, University for Development Studies and Tamale Teaching Hospital, Tamale, Northern Region, Ghana
- * E-mail: (ST); (MK)
| | - Katie W. Russell
- University of Utah Department of Surgery, Center for Global Surgery, Salt Lake City, Utah, United States of America
| | | | - Ali Jalali
- University of Utah Department of Economics, Health Economics Core, Population Health Research Foundation, Salt Lake City, Utah, United States of America
| | - Raymond R. Price
- University of Utah Department of Surgery, Center for Global Surgery, Salt Lake City, Utah, United States of America
| | - Micah G. Katz
- University of Utah Department of Surgery, Center for Global Surgery, Salt Lake City, Utah, United States of America
- * E-mail: (ST); (MK)
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20
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Lipnick MS, Mavoungou P, Gelb AW. The global capnography gap: a call to action. Anaesthesia 2018; 74:147-150. [PMID: 30341946 DOI: 10.1111/anae.14478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M S Lipnick
- Department of Anesthesia and Peri-operative Care, University of California, San Francisco, CA, USA
| | - P Mavoungou
- Department d'Anesthésie, ICO René Gauducheau, Saint Herblain, France
| | - A W Gelb
- Department of Anesthesia and Peri-operative Care, University of California, San Francisco, CA, USA
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21
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White MC, Barki BJ, Lerma SA, Couch SK, Alcorn D, Gillerman RG. A Prospective Observational Study of Anesthesia-Related Adverse Events and Postoperative Complications Occurring During a Surgical Mission in Madagascar. Anesth Analg 2018; 127:506-512. [DOI: 10.1213/ane.0000000000003512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Georgiou Ε, Mashini M, Panayiotou I, Efstathiou G, Efstathiou CI, Charalambous M, Irakleous I. Barriers and facilitators for implementing the WHO's safety surgical checklist: A focus group study among nurses. J Perioper Pract 2018; 28:339-346. [PMID: 29911920 DOI: 10.1177/1750458918780120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health's Organization's safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list's implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.
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Affiliation(s)
- Εvanthia Georgiou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Maria Mashini
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Irene Panayiotou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Georgios Efstathiou
- 3 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | | | - Melanie Charalambous
- 5 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus,
| | - Iraklis Irakleous
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
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Zoumenou E, Chobli M, le Polain de Waroux B, Baele PL. Twenty Years of Collaboration Between Belgium and Benin in Training Anesthesiologists for Africa. Anesth Analg 2018; 126:1321-1328. [DOI: 10.1213/ane.0000000000002772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Barreiro G, Mellin-Olsen J, Gore-Booth J. The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery. Anesth Analg 2018; 126:1400-1404. [DOI: 10.1213/ane.0000000000002543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ottaway AJ, Kabongo L. Prospective Observational Study of Intraoperative Anesthetic Events in District Hospitals in Namibia. Anesth Analg 2018; 126:632-638. [DOI: 10.1213/ane.0000000000002695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology. Indian J Otolaryngol Head Neck Surg 2018; 70:149-155. [PMID: 29456960 DOI: 10.1007/s12070-018-1253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
Abstract
The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.
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Olatosi JO, Anaegbu NC, Adesida A. Use of the World Health Organization Surgical Safety Checklist by Nigerian anesthetists. Niger J Surg 2018; 24:111-115. [PMID: 30283222 PMCID: PMC6158986 DOI: 10.4103/njs.njs_16_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Surgery and anesthesia are essential parts of global healthcare. Surgical intervention has been largely beneficial but remains associated with significant morbidity and mortality. The increasing complexity of surgical interventions has made providers more prone to avoidable errors. The World Health Organization Surgical Safety Checklist (WHO SSC) was disseminated worldwide with the aim of reducing perioperative morbidity and mortality. Objective There is a paucity of data to assess awareness and use of WHO SSC in low- and middle-income countries. The aim of this study is to evaluate the knowledge and use of WHO SSC by Nigerian anesthetists. Methodology A structured self-reporting questionnaire was distributed to Nigerian physician anesthetists. One hundred and twenty-two questionnaires were distributed with 102 completed reflecting a response rate of 83.6%. Results Awareness of the WHO SSC was reported by 93.1% of the respondents. Routine use of the checklist was reported by 62.7% of the respondents mostly in the teaching hospitals compared with the general hospitals and comprehensive health centers (86.2%, 23.3% and 14.3%, P = 0.0001). The respondents who had a perception that WHO SSC does not prevent errors were the least likely to use it (odds ratio: 0.08, P = 0.0117). Conclusion This study identified a high level of awareness and use of the WHO SSC by physician anesthetists in Nigeria. However, its use is mostly use of The WHO SSC list by Nigerian anesthetists in teaching hospitals.
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Affiliation(s)
- John Olutola Olatosi
- Department of Anaesthesia, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Adeniyi Adesida
- Department of Anaesthesia, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
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28
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Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia 2017; 73:93-111. [DOI: 10.1111/anae.14123] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
- T. M. Cook
- Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
- School of Clinical Sciences; Bristol University; Bristol UK
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Epiu I, Tindimwebwa JVB, Mijumbi C, Chokwe TM, Lugazia E, Ndarugirire F, Twagirumugabe T, Dubowitz G. Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa. Anesth Analg 2017; 124:290-299. [PMID: 27918334 DOI: 10.1213/ane.0000000000001690] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561). RESULTS Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country. CONCLUSIONS We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.
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Affiliation(s)
- Isabella Epiu
- From the *Department of Anaesthesia, University of California Global Health Institute - Makerere University College of Health Sciences, Kampala, Uganda; †Department of Anaesthesia, Mulago Hospital, Kampala, Uganda; ‡Department of Anaesthesia, University of Nairobi, Nairobi, Kenya; §Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ‖Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi; ¶University of Rwanda, Kigali, Rwanda; and #Department of Anaesthesia and Perioperative Care, University of California, San Francisco
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Koka R, Chima AM, Sampson JB, Jackson EV, Ogbuagu OO, Rosen MA, Koroma M, Tran TP, Marx MK, Lee BH. Anesthesia Practice and Perioperative Outcomes at Two Tertiary Care Hospitals in Freetown, Sierra Leone. Anesth Analg 2017; 123:213-27. [PMID: 27088997 DOI: 10.1213/ane.0000000000001285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesia in West Africa is associated with high mortality rates. Critical shortages of adequately trained personnel, unreliable electrical supply, and lack of basic monitoring equipment are a few of the unique challenges to surgical care in this region. This study aims to describe the anesthesia practice at 2 tertiary care hospitals in Sierra Leone. METHODS We conducted an observational study of anesthesia care at Connaught Hospital and Princess Christian Maternity Hospital in Freetown, Sierra Leone. Twenty-five percent of the anesthesia workforce in Sierra Leone, resident at both hospitals, was observed from June 2012 to February 2013. Perioperative assessments, anesthetic techniques, and intraoperative clinical and environmental irregularities were noted and analyzed. The postoperative status of observed cases was ascertained for morbidity and mortality. RESULTS Between the 2 hospitals, 754 anesthesia cases and 373 general anesthetics were observed. Ketamine was the predominant IV anesthetic used. Both hospitals experienced infrastructural and environmental constraints to the delivery of anesthesia care during the observation period. Vital sign monitoring was irregular and dependent on age and availability of monitors. Perioperative mortality during the course of the study was 11.9 deaths/1000 anesthetics. CONCLUSIONS We identified gaps in the application of internationally recommended anesthesia practices at both hospitals, likely caused by lack of available resources. Mortality rates were similar to those in other resource-limited countries.
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Affiliation(s)
- Rahul Koka
- From the *Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; †Armstrong Institute of Patient Safety and Quality, Baltimore, Maryland; and ‡Department of Anesthesia, Ministry of Health and Sanitation, Freetown, Sierra Leone
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Baxter LS, Ravelojaona VA, Rakotoarison HN, Herbert A, Bruno E, Close KL, Andean V, Andriamanjato HH, Shrime MG, White MC. An Observational Assessment of Anesthesia Capacity in Madagascar as a Prerequisite to the Development of a National Surgical Plan. Anesth Analg 2017; 124:2001-2007. [DOI: 10.1213/ane.0000000000002049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ellis R, Izzuddin Mohamad Nor A, Pimentil I, Bitew Z, Moore J. Improving Surgical and Anaesthesia Practice: Review of the Use of the WHO Safe Surgery Checklist in Felege Hiwot Referral Hospital, Ethiopia. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu207104.w6251. [PMID: 28321296 PMCID: PMC5337669 DOI: 10.1136/bmjquality.u207104.w6251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/10/2017] [Indexed: 12/20/2022]
Abstract
Development of surgical and anaesthetic care globally has been consistently reported as being inadequate. The Lancet Commission on Global Surgery highlights the need for action to address this deficit. One such action to improve global surgical safety is the introduction of the WHO Surgical Checklist to Operating Rooms (OR) around the world. The checklist has a growing body of evidence supporting its ability to assist in the delivery of safe anaesthesia and surgical care. Here we report the introduction of the Checklist to a major Ethiopian referral hospital and low-resource setting and highlight the success and challenges of its implementation over a one year period. This project was conducted between July 2015 and August 2016, within a wider partnership between Felege Hiwot Hospital and The University of Aberdeen. The WHO Surgical Checklist was modified for appropriate and locally specific use within the OR of Felege Hiwot. The modified Checklist was introduced to all OR's and staff instructed on its use by local surgical leaders. Assessment of use of the Checklist was performed for General Surgical OR in three phases and Obstetric OR in two phases via observational study and case note review. Training was conduct between each phase to address challenges and promote use. Checklist utilisation in the general OR increased between Phase I and 2 from 50% to 97% and remained high at 94% in Phase 3. Between Phase I and 2 partial completion rose from 27% to 77%, whereas full completion remained unchanged (23% to 20%). Phase 3 resulted in an increase in full completion from 20% to 60%. After 1 year the least completed section was "Sign In" (53%) and "Time Out" was most completed (87%). The most poorly checked item was "Site Marked" (60%). Use of the checklist in Obstetrics OR increased between Phase I and Phase II from 50% to 100% with some improvement in partial completion (50% to 60%) and a notable increase in full completion (0% to 40%). The least completed section was "Time Out" (50%) and "Sign In" was the most completed (90%). The most poorly checked item was "Recovery Concerns" (70%). There was considerable enthusiasm for use of the checklist among staff. The greatest challenge was communication difficulties between teams and high staff turnover. This study records a locally driven, successful introduction of the WHO Surgical Safety Checklist modified for the specific locale and illustrates an increase in use of the checklist over a one year period in both General Surgical and Obstetric OR's. Local determination and ownership of the Checklist with regular intervention to promote use and train users contributed to this success.
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Alfa-Wali M, Osaghae S. Practice, training and safety of laparoscopic surgery in low and middle-income countries. World J Gastrointest Surg 2017; 9:13-18. [PMID: 28138364 PMCID: PMC5237818 DOI: 10.4240/wjgs.v9.i1.13] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/03/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Surgical management of diseases is recognised as a major unmet need in low and middle-income countries (LMICs). Laparoscopic surgery has been present since the 1980s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with high-income countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.
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White MC, Horner KC, Lai PS. Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa. PLoS One 2016; 11:e0165090. [PMID: 27788172 PMCID: PMC5082919 DOI: 10.1371/journal.pone.0165090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/18/2016] [Indexed: 11/25/2022] Open
Abstract
Background Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Materials and Methods Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. Results 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Conclusion Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery.
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Affiliation(s)
- Michelle C. White
- Department of Anaesthesia, Mercy Ships, Port au Toamasina, Region 12, Madagascar
- * E-mail:
| | - Katherine C. Horner
- Department of Anaesthesia, Mercy Ships, Port au Toamasina, Region 12, Madagascar
| | - Peggy S. Lai
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, United States of America
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Epiu I, Tindimwebwa JVB, Mijumbi C, Ndarugirire F, Twagirumugabe T, Lugazia ER, Dubowitz G, Chokwe TM. Working towards safer surgery in Africa; a survey of utilization of the WHO safe surgical checklist at the main referral hospitals in East Africa. BMC Anesthesiol 2016; 16:60. [PMID: 27515450 PMCID: PMC4982013 DOI: 10.1186/s12871-016-0228-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Mortality from anaesthesia and surgery in many countries in Sub-Saharan Africa remain at levels last seen in high-income countries 70 years ago. With many factors contributing to these poor outcomes, the World Health Organization (WHO) launched the “Safe Surgery Saves Lives” campaign in 2007. This program included the design and implementation of the “Surgical Safety Checklist”, incorporating ten essential objectives for safe surgery. We set out to determine the knowledge of and attitudes towards the use of the WHO checklist for surgical patients in national referral hospitals in East Africa. Methods A cross-sectional survey was conducted at the main referral hospitals in Mulago (Uganda), Kenyatta (Kenya), Muhimbili (Tanzania), Centre Hospitalier Universitaire de Kigali (Rwanda) and Centre Hospitalo-Universitaire de Kamenge (Burundi). Using a pre-set questionnaire, we interviewed anaesthetists on their knowledge and attitudes towards use of the WHO surgical checklist. Results Of the 85 anaesthetists interviewed, only 25 % regularly used the WHO surgical checklist. None of the anaesthetists in Mulago (Uganda) or Centre Hospitalo-Universitaire de Kamenge (Burundi) used the checklist, mainly because it was not available, in contrast with Muhimbili (Tanzania), Kenyatta (Kenya), and Centre Hospitalier Universitaire de Kigali (Rwanda), where 65 %, 19 % and 36 %, respectively, used the checklist. Conclusion Adherence to aspects of care embedded in the checklist is associated with a reduction in postoperative complications. It is therefore necessary to make the surgical checklist available, to train the surgical team on its importance and to identify local anaesthetists to champion its implementation in East Africa. The Ministries of Health in the participating countries need to issue directives for the implementation of the WHO checklist in all hospitals that conduct surgery in order to improve surgical outcomes.
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Affiliation(s)
- Isabella Epiu
- Fogarty Global Health Fellow, University of California Global Health Institute (UCGHI), San Francisco, California, USA. .,Department of Anaesthesia, Makerere University College of Health Sciences, P.O. BOX 7072, Kampala, Uganda.
| | | | | | | | | | | | | | - Thomas M Chokwe
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
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Cooper MG, Wake PB, Morriss WW, Cargill PD, McDougall RJ. Global safe anaesthesia and surgery initiatives: implications for anaesthesia in the Pacific region. Anaesth Intensive Care 2016; 44:420-4. [PMID: 27246944 DOI: 10.1177/0310057x1604400318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2015 three major events occurred for global anaesthesia and surgery. In January, the World Bank published Disease Control Priorities 3rd edition (DCP 3rd edition). This volume, Essential Surgery, highlighted the cost effective role of anaesthesia and surgery in global health. In April, the Lancet Commission on Global Surgery released its report "Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development". The report focuses on five key areas to promote change including: access to timely surgery, surgical workforce and procedural capability, surgical volume, data collection such as perioperative mortality rate, and financial protection. In May, the 68th World Health Assembly (WHA) voted in favour of Resolution A68/31: Strengthening emergency and essential surgical and anaesthesia care as a component of universal health coverage. The resolution was passed unanimously and it is the first time that surgery and anaesthesia have received such prominence at WHA level. These three events all have profound implications for the provision and access of safe anaesthesia and surgery in the Pacific region in the next 15 years. This article considers some of the regional factors that affect these five key areas, especially with regard to anaesthetic specialist workforce density in different parts of the region. There are many challenges to improve anaesthesia access, safety, and workforce density in the Pacific region. Future efforts, initiatives and support will help address these problems.
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Affiliation(s)
- M G Cooper
- Chair, Overseas Aid Committee, Australian & New Zealand College of Anaesthetists, Adjunct Professor of Anaesthesiology, University of Papua New Guinea, Papua New Guinea, Senior Anaesthetist, Department of Anaesthesia, The Children's Hospital at Westmead and St George Hospital, Sydney, New South Wales
| | - P B Wake
- Lecturer, Discipline of Anaesthesiology and Intensive Care, School of Medicine and Health Sciences, University of Papua New Guinea, Papua New Guinea
| | - W W Morriss
- Chair, Education Committee, World Federation of Societies of Anaesthesiologists, Consultant Anaesthetist, Department of Anaesthesia, Christchurch Hospital, Christchurch, New Zealand
| | - P D Cargill
- Policy Officer, Australian & New Zealand College of Anaesthetists, Melbourne, Australia
| | - R J McDougall
- Honorary Clinical Associate Professor, The University of Melbourne, Chair, Overseas Development and Education Committee, Australian Society of Anaesthetists, Anaesthetist, Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria
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Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital. Int J Gynaecol Obstet 2016; 134:181-5. [DOI: 10.1016/j.ijgo.2015.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/24/2015] [Accepted: 04/01/2016] [Indexed: 11/17/2022]
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Kim Y, Kim JM, Lee SG, Lee KY, Hong KH, Lee KH, Kim DK, Hong SJ. The State of Anesthetic Services in Korea: A National Survey of the Status of Anesthesia Provider in the 2011-2013 Period. J Korean Med Sci 2016; 31:131-8. [PMID: 26770049 PMCID: PMC4712572 DOI: 10.3346/jkms.2016.31.1.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/23/2015] [Indexed: 11/20/2022] Open
Abstract
Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services.
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Affiliation(s)
- Yongsuk Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Man Kim
- Department of Health Business Administration, Woosong University, Daejeon, Korea
| | - Sang Gyu Lee
- Graduate School of Public Health, Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Ki-Young Lee
- Deparment of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Hyuk Hong
- Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Kook Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Kyu Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Jin Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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A New Approach to Teaching Obstetric Anaesthesia in Low-Resource Areas. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:880-4. [DOI: 10.1016/s1701-2163(16)30021-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Avoidable perioperative mortality at the University Teaching Hospital, Lusaka, Zambia: a retrospective cohort study. Can J Anaesth 2015; 62:1259-67. [DOI: 10.1007/s12630-015-0483-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/03/2015] [Accepted: 09/01/2015] [Indexed: 11/25/2022] Open
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Bosse G, Abels W, Mtatifikolo F, Ngoli B, Neuner B, Wernecke K, Spies C. Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals. PLoS One 2015; 10:e0136156. [PMID: 26327392 PMCID: PMC4556680 DOI: 10.1371/journal.pone.0136156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 07/31/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. METHODS All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. RESULTS Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. DISCUSSION Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. CONCLUSION Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.
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Affiliation(s)
- Goetz Bosse
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—University Medicine Berlin, Berlin, Germany
- * E-mail:
| | - Wiltrud Abels
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—University Medicine Berlin, Berlin, Germany
| | | | - Baltazar Ngoli
- Component Leader Quality Improvement, Tanzanian-German Program To Support Health (TGPSH), giz Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Dar-es-Salaam, Tanzania
| | - Bruno Neuner
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—University Medicine Berlin, Berlin, Germany
| | | | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—University Medicine Berlin, Berlin, Germany
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Hagander L, Kabir M, Chowdhury MZ, Gunnarsdóttir A, Habib MG, Banu T. Major neonatal surgery under local anesthesia: a cohort study from Bangladesh. World J Surg 2015; 39:953-60. [PMID: 25446485 DOI: 10.1007/s00268-014-2895-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgeons and anesthetists must respond to the perioperative mortality associated with general anesthesia in developing countries. The safety of performing major neonatal surgery under local anesthesia is one pragmatic response. This study describes and evaluates such practice in a tertiary pediatric surgery center in Bangladesh. METHODS Seven hundred and twenty neonates were admitted for major surgery during a 3.5-year study period. Hundred and fifty two neonates died pre-operatively, and 568 underwent major neonatal surgery. 352 (62.0%) neonates were operated under general anesthesia, while the 216 most fragile neonates (38.0%) were operated with local infiltrative anesthesia alone. Medical files were reviewed; data were collected prospectively; mortality risk factors were assessed by univariate and multivariate analysis. RESULTS Two hundred and sixteen procedures were performed under local anesthesia: sigmoid colostomies (37.5%), laparotomies with anastomosis (21.3%), anoplasties (18.1%), laparotomies with enterostomy (8.3%), closures of abdominal wall defects (6.9%), fixations of silastic bags (3.7%), peritoneal tube drainage (2.3%), and gastrostomies (1.9%). Median weight was 2,400 g (2,200-2,460), median gestational age was 37.0 weeks (36.0-38.0), and median age at surgery was 5.0 days (3.0-14.7). In-hospital postoperative mortality was 10.6% among those selected for local anesthesia, and 11.4% among neonates operated under general anesthesia. Low birth weight was an independent risk factor for mortality on multivariate analysis (OR 1.002 g(-1), 95% CI [1.000-1.004], p = 0.029). CONCLUSIONS Local anesthesia is an established option for the most fragile neonates with major surgical disease. Safe anesthesia ought to be accessible to all children of the world. The global pandemic of perioperative mortality needs to be addressed.
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Affiliation(s)
- L Hagander
- Department of Pediatric Surgery, Children's Hospital, Lund, Sweden,
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Sama HD, Maman AFOB, Walker IA. Incidence of hypoxia and related events detected by pulse oximeters provided by the Lifebox Foundation in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo. J Anesth 2015. [PMID: 26198600 DOI: 10.1007/s00540‐015‐2048‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In recent decades anesthesia safety has not been improved in low-income countries. This prospective audit describes the incidence of hypoxia and related events detected among a cohort of patients undergoing surgery in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo, West Africa, by using pulse oximeters donated by the Lifebox Foundation. The Lifebox oximeter enables early detection of hypoxia for patients undergoing surgery before irreversible damage occurs. Pulse oximetry is cost-effective intervention and should be more accessible in all operating rooms of this type.
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Affiliation(s)
- H D Sama
- Department of Anesthesia and Critical Care Medicine, Sylvanus Olympio University Teaching Hospital, Lomé, 08 BP, 8146, Togo.
| | | | - I A Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Abstract
PURPOSE OF REVIEW The global burden of surgical disease is significant and growing. As a result, the vital role of essential surgical care and safe anesthesia in low-income and middle-income countries is gaining increasing attention. Importantly, vast disparities in access to essential surgery and safe anesthesia exist. In this review, we summarize the current knowledge surrounding the global crisis of inadequate anesthesia capacity and barriers to patient safety in low-income and middle-income countries. RECENT FINDINGS The major patient safety challenges in low-income and middle-income countries include a lack of well trained anesthesia providers, inadequate infrastructure, equipment, monitors, medicines, oxygen, and blood products, and an absence of meaningful data to guide policies and programs. SUMMARY Explicit mention of essential surgery and safe anesthesia in the Post-2015 Development Agenda is a critical step forward in advancing the cause of global perioperative care. Tracking surgical and anesthesia outcomes with a metric, such as the perioperative mortality rate, must be required at the hospital, country, and global level to guide improvement of surgical and anesthetic interventions aimed at the burden of surgical disease.
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Petersen CL, Gan H, MacInnis MJ, Dumont GA, Ansermino JM. Ultra-low-cost clinical pulse oximetry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:2874-7. [PMID: 24110327 DOI: 10.1109/embc.2013.6610140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An ultra-low-cost pulse oximeter is presented that interfaces a conventional clinical finger sensor with a mobile phone through the headset jack audio interface. All signal processing is performed using the audio subsystem of the phone. In a preliminary volunteer study in a hypoxia chamber, we compared the oxygen saturation obtained with the audio pulse oximeter against a commercially available (and FDA approved) reference pulse oximeter (Nonin Xpod). Good agreement was found between the outputs of the two devices.
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McQueen K, Coonan T, Ottaway A, Hendel S, Bagutifils PR, Froese A, Neighbor R, Perndt H. The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety. World J Surg 2015; 39:2153-60. [DOI: 10.1007/s00268-015-3101-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bordes J, Cungi PJ, Savoie PH, Bonnet S, Kaiser E. Usefulness of routine preoperative testing in a developing country: a prospective study. Pan Afr Med J 2015; 21:94. [PMID: 26516395 PMCID: PMC4606028 DOI: 10.11604/pamj.2015.21.94.5860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/22/2015] [Indexed: 12/14/2022] Open
Abstract
Introduction The assessment of anesthetic risks is an essential component of preoperative evaluation. In developing world, preanesthesia evaluation may be challenging because patient's medical history and records are scare, and language barrier limits physical examination. Our objective was to evaluate the impact of routine preoperative testing in a low-resources setting. Methods Prospective observational study performed in a French forward surgical unit in Abidjan, Ivory Coast. 201 patients who were scheduled for non urgent surgery were screened with routine laboratory exams during preoperative evaluation. Changes in surgery were assessed (delayed or scheduled). Results Abnormal hemoglobin findings were reported in 35% of patients, abnormal WBC count in 11,1% of patients, abnormal platelets in 15,3% of patients. Positive HIV results were found in 8,3% of cases. Routine tests represented 43,6% of changes causes. Conclusion Our study showed that in a developing country, routine preoperative tests showed abnormal results up to 35% of cases, and represented 43,5% of delayed surgery causes. The rate of tests leading to management changes varied widely, from 0% to 8,3%. These results suggested that selected tests would be useful to diagnose diseases that required treatment before non urgent surgery. However, larger studies are needeed to evaluate the cost/benefit ratio and the clinical impact of such a strategy.
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Affiliation(s)
- Julien Bordes
- Département d'Anesthésie-Réanimation, HIA Sainte Anne, Toulon, France
| | | | | | | | - Eric Kaiser
- Département d'Anesthésie-Réanimation, HIA Sainte Anne, Toulon, France
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Chao TE, Mandigo M, Opoku-Anane J, Maine R. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc 2015; 30:1-10. [PMID: 25875087 DOI: 10.1007/s00464-015-4201-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 03/31/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. METHODS A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. RESULTS A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. CONCLUSIONS LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.
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Affiliation(s)
- Tiffany E Chao
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB 425, Boston, MA, 02114, USA. .,Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Morgan Mandigo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Opoku-Anane
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rebecca Maine
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Denny L. Control of Cancer of the Cervix in Low- and Middle-Income Countries. Ann Surg Oncol 2015; 22:728-33. [DOI: 10.1245/s10434-014-4344-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Indexed: 11/18/2022]
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