Providing Anesthesia Care in Resource-limited Settings

Abstract

Background Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. Methods The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Results Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. Conclusions A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

Assessing the global reach and value of a provider-facing healthcare app using large-scale analytics

“…As an example of this type of information, a retrospective MSF study in resource-limited settings demonstrated that general anaesthesia with intubation carries mortality risk as compared with other anaesthetic techniques. 46 …”

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

“… 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. The few studies from developing countries that exist show a lower risk of death in patients receiving regional instead of general anesthesia.…”

Anesthesia Provision in Disasters and Armed Conflicts

“…MSF actions are guided by medical ethics and the principles of independence, neutrality and impartiality. MSF has an important experience in the provision of surgical care, including safe anesthesia, in highly challenging settings – this experience principally relies on a wide flexibility, and delivery of relatively standardized care, which is only minimally tailored to a given setting; and also, for which standard operative procedures have been developed [ 4 ].…”