Low resource anesthesia

INTRODUCTION AND HISTORY: In Mongolia, pediatric anesthesia has advanced during the past 25 years through expanded, standardized education programs and international collaboration. Pediatric anesthesia is a recognized specialty, covering all surgical services, including cardiac and transplant, using physicians and nurses. TRAINING: The pediatric anesthesia fellowship is 6 months after 2 years of residency; pediatric nurse anesthesia training is 6 months...

BACKGROUND: Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. OBJECTIVE: Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate...

An estimated 1.7 billion children and adolescents do not have access to safe and affordable surgical care, and the vast majority of these are located in low-middle-income countries (LMICs). Pediatric anesthesia, a specialized field that requires a diverse set of knowledge and skills, has seen various advancements over the years and has become well-established in upper-middle and high-income countries. However, in LMICs, due to a multitude of factors including severe workforce shortages, this has not been the case...

INTRODUCTION: Pediatric radiotherapy (PR) faces several issues in middle- and low-income countries. AIM: Our study is a cross-sectional observation which aimed to describe the current situation of PR in Morocco in order to identify the needs and to propose an organizational shema for this discipline. METHODS: The collection of data used two surveys, one of which was intended to the heads of the radiotherapy department of all university hospital centers (UHC) in Morocco concerning the hospital's infrastructure, human resources, technical and the course of radiotherapy...

BACKGROUND: In the last 30 years, significant advances have been made in pediatric medical care globally. However, there is a persistent urban-rural gap which is more pronounced in low middle-income countries than high-income countries, similar urban-rural gap exists in India. While on one hand, health care is on par or better than healthier nations thriving international medical tourism industry, some rural parts have reduced access to high-quality care. AIM: With this background, we aim to provide an overview of the present and future of healthcare in India...

Tracheostomy is commonly performed in patients to secure the airway. There are known early and late complications related to tracheostomy. Few case reports have described the rupture of the stem of the tracheostomy tube and its migration into the tracheobronchial tree. Here we describe a pediatric case with a broken stem of the tracheostomy tube in the trachea, acting as a foreign body and causing mild respiratory distress. The patient was successfully managed with neck exploration under general anesthesia using a supraglottic airway device in low-resource settings...

BACKGROUND: Colorectal cancer is a prevalent and serious health concern globally, particularly among the elderly population. Laparoscopic surgery is a commonly used approach for colorectal cancer treatment. However, the use of appropriate anesthesia and muscle relaxants is essential to ensure optimal surgical outcomes. Elderly patients undergoing surgery often have unique physiological characteristics and comorbidities, such as hypertension, diabetes, and coronary heart disease. These factors can affect treatment efficiency and patient outcomes...

PURPOSE OF REVIEW: Simulation-based training remains an integral component of medical education by providing a well tolerated, controlled, and replicable environment for healthcare professionals to enhance their skills and improve patient outcomes. Simulation technology applied to obstetric anesthesiology continues to evolve as a valuable tool for the training and assessment of the multidisciplinary obstetric care team. RECENT FINDINGS: Simulation-based technology has continued to play a role in training and assessment, including recent work on interdisciplinary communication, recognition, and management of obstetric hemorrhage, and support in the low or strained resource setting...

BACKGROUND: Overuse of sedation and anesthesia causes delays in gastrojejunostomy tube (GJ) exchanges, increased risk of complications, unnecessary use of resources, preventable hospital admissions, and an adverse impact on patient and family experience. Our hospital was over-utilizing sedation and anesthesia, and we aimed to decrease this use from 78% to 20% within two years. METHODS: An interdisciplinary quality improvement team comprehensively evaluated current processes for GJ tube exchanges through a retrospective chart review for baseline data with prospective time series analysis after improvement implementation...

INTRODUCTION: Pain management for trauma in the extreme environment is vital for both casualty comfort and aiding safe extrication. However, adequate pain management in a resource-limited environment can be challenging and is often limited. We conducted a scoping review of the use of regional anesthesia in the prehospital environment, evaluating which regional anesthetic procedure was performed for various indications, their efficacy, and the type of healthcare provider delivering the anesthetic...

BACKGROUND: 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models...

BACKGROUND: Nitrous oxide has been an integral part of surgical anesthesia for many years in the developed world and is still used in developing countries such as India. The other main concerns in low-resource countries are the lack of an advanced anesthesia gas-scavenging system and modular surgical theatres. As a greenhouse gas that has been present in the atmosphere for more than 100 years and damages the ozone layer, nitrous oxide is three times worse than sevoflurane. Here, we conducted an observational study to quantify the annual nitrous oxide consumption and its environmental impact in terms of carbon dioxide equivalence in one of busiest tertiary health care and research centers in Northern India...

PURPOSE: To evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). METHODS: From September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs...

INTRODUCTION AND IMPORTANCE: Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment...

BACKGROUND: Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being...

INTRODUCTION: Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills...

BACKGROUND: The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman-Herfindahl index (HHI). METHODS: This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017...

INTRODUCTION: Children, especially those under the age of five, seldom get hip dislocations. Young children may sustain dislocations from minor accidents such as slips or falls from low heights, whereas adolescents typically do so from high-intensity events such as car crashes or collision sports. Posterior dislocation occurs 8-9 times more frequently than those in the anterior. Here, we describe about the acute posterior hip dislocation suffered by a 5-year-old boy in this case report...

Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience...

OBJECTIVES: It remains unclear whether intraoperative lung-protective strategies can reduce the rate of respiratory complications after cardiac surgery, partly because low-risk patients have been studied in the past. The authors established a screening model to easily identify a high-risk group for severe pulmonary complications (ie, pneumonia or acute respiratory distress syndrome) that may be the ideal target population for the assessment of the potential benefits of such measures. DESIGN: Retrospective observational trial...