Adaptations in pediatric anesthesia care and airway management in the resource‐poor setting

Abstract

The need for safe and quality pediatric anesthesia care in low‐ and middle‐income countries (LMICs) is huge. An estimated 1.7 billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non‐physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low‐resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric‐sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low‐fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.

Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

“…Fellowship training to develop more leaders and educators will be essential if we are to improve the quality of pediatric anesthesia training for both physician and non‐physician anesthesia trainees. Undertaking such training is essential for the provision of safe, quality anesthetic care to pediatric surgical patients, particularly neonates and infants who present with physiologies and problems not encountered in adults [19, 20]. In order to specifically scale up the density of pediatric anesthesia providers in LMICs, more pediatric anesthesia‐specific training opportunities need to be made available.…”

Challenges of Anesthetic Monitoring in Low- and Middle-Income Countries: Availability of Equipment in Major Referral Hospitals in Kenya

“…18–20 The 50.5% unavailability of pediatric/neonatal size pulse oximeter probes offers significant challenges to safe pediatric anesthesia. 20 This inadequate availability of pediatric-sized anesthesia equipment in low- and middle-income countries has been affirmed by Manyumwa et al 21…”

“…[18][19][20] The 50.5% unavailability of pediatric/neonatal size pulse oximeter probes offers significant challenges to safe pediatric anesthesia. 20 This inadequate availability of pediatric-sized anesthesia equipment in 21 Temperature monitoring was present in 73 of 103 (70.9%) operating theaters, indicating the absence in the remaining 30 (29.1%) operating theaters. This could increase the risk of hypothermia for procedures lasting >30 minutes.…”

Gaps and priorities in innovation for children's surgery

“…Single-use equipment that is available is routinely reused after cleaning with antiseptics and the infection transmission rate remains unquantified. 21 Supply chain issues are complex, as recently experienced by HICs during the COVID-19 pandemic, and are more chronic and severe in LMICs. 22 Technology that has passed rigorous safety testing in HICs is usually believed to be safe for use in LMICs without concerns for patient harm.…”