Anesthesia for Cesarean Delivery: A Cross-Sectional Survey of Provincial, District, and Mission Hospitals in Zimbabwe

Abstract

This study identified areas where anesthetic provision and care could be improved. Provincial hospitals, where district/mission hospitals refer difficult cases, did not have the higher level anesthesia expertise required to manage these cases. More intensive mentorship and supervision from senior clinicians is essential to address the shortcomings identified in this survey, such as the implementation of evidence-based safe practices, supply chain failures, high maternal morbidity, and mortality. Training of medical officers and NAs should be strengthened in leadership, team work, and management of complications.

Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings

“… 7 , 27 – 31 The reported deaths that are linked to anesthetic care are believed to largely be a result of airway and respiratory problems, and inadequate volume resuscitation during general anesthesia or in the postoperative period. 7 , 12 , 32 , 33 An increase in anesthetic mortality in LMICs is not surprising considering the deficiencies of anesthetic equipment, drugs, basic monitors, safety protocols, and well-trained anesthesiologists and anesthetists. 4 , 34 Although resources are slowly improving, it seems reasonable that every effort should be made in these countries to use the anesthetic techniques that are safest under the present conditions.…”

“…In LRCs where anesthesia practitioners have less training on average, little backup, and limited access to advanced equipment, it seems reasonable that neuraxial regional anesthesia should also be the anesthetic of choice for obstetrical patients. 12 In addition to being considered safe and effective, neuraxial anesthesia is relatively easy to teach and perform. It is felt by many to be the anesthetic of choice in LRCs for surgeries at and below the umbilicus.…”

“…These are the very cases that most commonly present for surgery in low-and-middle-income countries (LMICs). 12 – 14 Benefits of using regional rather than general anesthesia include fewer life-threatening perioperative airway and respiratory complications, especially in obstetrical patients and patients with pre-existing lung disease. The use of neuraxial anesthesia has been found to decrease blood loss during orthopedic hip surgery and to lower the incidence of post-operative blood clots after lower limb surgery.…”

CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations—Implication for Drug Safety, Dosing, and Individualized Therapy

“…Although ketamine has a large therapeutic window, its use is limited due to low efficacy and huge interindividaul variability in treatment response including ADRs that require cessation of therapy (Kvarnström et al, 2004 ; Noppers et al, 2010 ; Laskowski et al, 2011 ; Hardy et al, 2012 ; Perez-Ruixo et al, 2020 ). Ketamine has been associated with increased blood pressure, alteration of speech, muscular discoordination, euphoria, hallucination, loss of consciousness, seizure, nausea, out of body experience, hypothermia, traffic accident or drowning and irrational behavior (Iyalomhe and Iyalomhe, 2014 ; Lonnée et al, 2018 ; Gajewski et al, 2020 ).…”

“…LMICs are lacking in the provision and training for safe anesthesia practice. In a cross-sectional survey made in Zimbabwe involving 42 hospitals, the number of specialist physician anesthetics were limited (Lonnée et al, 2018 ). Further, 19% of the nurse anesthetists have had no formal training (Lonnée et al, 2018 ).…”