The Capnography Project

Capnography is an essential tool used in the monitoring of patients during anesthesia and in critical care which, while required in most high-income countries, is unavailable in many low- and middle-income countries. Launched in 2020, the Smile Train-Lifebox Capnography Project aimed to find a "capnography solution" for resource-poor settings. The project was specifically interested in a capnography device that would meet the needs of the Smile Train partner hospitals to help monitor children requiring airway or cleft surgery. Project advisory and technical groups were formed and included representation from anesthesia practitioners from a balanced representation from all level of income countries, technical experts in capnography, and representatives from the Global Capnography Project (GCAP), the University of California at San Francisco Center for Health Equity in Surgery & Anesthesia (CHESA), and the World Federation of Societies of Anaesthesiologists (WFSA). Built upon the WFSA minimum capnometer specifications, a human centered design approach was used to develop a Target Product Profile. Seven manufacturers submitted 13 devices for consideration and 3 devices were selected for the testing phase. Each of these devices was evaluated for build quality, and clinical and usability performance. Based on the findings from the overall testing process, a combined capnography and pulse oximetry device by Zug Medical Systems was chosen. To accompany the new Smile Train-Lifebox capnograph, an international team of experienced anesthesiologists and educators came together to develop the necessary education materials. These materials were piloted in Ethiopia, subsequently modified, and endorsed by the education team. The device is now ready for distribution, with the accompanying education package, to the Smile Train network and beyond. In addition, a study is being planned to measure the impact of capnography introduction into operating rooms in resource-constrained settings.

The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries

Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.

Review article: safety aspects of anesthesia in under-resourced locations

PURPOSE

Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world.

PRINCIPAL FINDINGS

There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization's Surgical Safety Checklist could further reduce morbidity and mortality.

CONCLUSIONS

Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.

Safe perioperative pediatric care around the world

Pediatric anesthesia is no longer a small subspecialty, but an important sector where developments in the new century have brought effective and safe management to children in the perioperative period. Unfortunately, what is common daily practice in the high-income countries with all the guidelines, checklists, instruments, and dedicated pediatric anesthesiologists is often only a dream in the low- and middle-income countries where the basic anesthesia services for improving the high rate of morbidity and mortality still are lacking. Anesthesia given by nonphysicians, with no monitoring, lack of elementary supplies, poor control of infections and hemorrhage, and no water or electricity are very often the 'usual' conditions. The World Health Organization is working hard to offer teams, basic equipments, and teaching and what is needed to offer children of these countries the same opportunities given in the industrialized countries. Other projects such as the Lifebox Project have a similar aim. This paper outlines some of what organizations are doing around the world, with different strategies all having the same target: safe pediatric anesthesia.

The World Federation of Societies of Anaesthesiologists and Pediatric Anesthesia

The World Federation of Societies of Anaesthesiologists (WFSA) is an organization whose principal goal is to improve the standard of anesthesia worldwide. The education and pediatric committees focus on the needs of pediatric patients in developing countries. Subspecialty training in pediatric anesthesia is supported in several regions. The publications committee supports the distribution of textbooks in pediatric anesthesia.

[World Federation of Societies of Anaesthesiologists (WFSA) - security in anaesthesia - worldwide]

In many countries of the world, standards of anaesthesiology are poor. Even the most modern equipment cannot be used properly without people who are able to work and deal with it. So education is a crucial requirement. Since 1955, the World Federation of Societies of Anaesthesiologists (WFSA) trains anaethesiologists worldwide to improve the standards of medicine in developing countries. The society works closely with WHO, ESA, FEEA and other international societies. Its aim: to make surgery safer throughout the world.

Prevalence and clinical characteristics of borderline patients in an eating-disordered population

Ninety-four consecutive patients seeking treatment for eating disorders were evaluated for eating attitudes and behaviors, weight history, psychiatric symptoms, psychosocial stressors, social adaptation, family environment, and the presence of borderline personality organization. The patients were divided into borderline and nonborderline groups and were compared on the above dimensions, with 46% of the patients showing borderline personality features. The borderline patients and the nonborderline patients had relatively few differences in the severity of their symptomatic eating behaviors and attitudes. The borderline patients, however, were significantly more disturbed on a number of relevant dimensions, including general psychiatric symptoms, psychosocial adaptation, family environment, self-destructive behavior, and treatment history. The authors suggest, on the basis of their findings and the findings of previous studies, that about one third of eating-disordered patients have marked borderline characteristics. They recommend that research studies in the future control for the eating-disordered patients' character pathologies. They also recommend that clinicians use a combination of long-term relationship-oriented treatment and psychopharmacological treatment with eating-disordered patients who have borderline personality disorder.