The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety

Abstract

Influential international organizations have historically published anaesthesia guidelines, but for the most part, without impacting substantial documentable changes or outcomes in low-income environments. This analysis, and subsequent recommendations, reviews the effectiveness of existing strategies for international guidelines, and proposes practical, step-wise implementation of patient safety approaches for LMICs.

In Reply: Comment on “Encouraging a bare minimum while striving for the gold standard: a response to the updated WHO-WFSA guidelines”

“…9 We suggest instead a bare minimum, with planned scale-up to the highly recommended guidelines, so that a hernia can be repaired before becoming incarcerated, and an elective Cesarean Delivery can be performed before it becomes an emergency, at which point the life of the mother or baby or both are already at risk. 10 We acknowledge the inclusive process of an NSOAP and applaud this effort. But we must report that, from the National Anesthesia Society perspective and the comments of participating physician anesthesiologists, the anesthesia perspective is not always heard, even when anesthesiologists engage.…”

Encouraging a bare minimum while striving for the gold standard: a response to the updated WHO–WFSA guidelines

“…In this spirit, we ask the global anesthesia community to embrace a bare minimum for safe practice as an important addendum to these essential, but not yet universally achievable guidelines. 5 Bare minimum guidelines represent a metaphorical line in the sand, beyond which surgery should not occur, but by the same token, every anesthesia provider must have the chance to provide safe anesthesia today while working towards the ideal tomorrow. Without practical solutions found in the real world, we risk being irrelevant partners to our peers who live and work in it.…”

In reply: Encouraging a bare minimum while striving for the gold standard: a response to the updated WHO-WFSA guidelines

“…Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia 2,3 reiterating their previously stated concern that such standards set the bar too high. 4 The WHO-WFSA workgroup was globally representative and was balanced for sex, geography, and high-, middle-, and low-income country membership. Thus, the advice of representatives from low-income countries in different parts of the world was sought and included.…”

“…The WHO-WFSA International Standards for a Safe Practice of Anesthesia are proving to be an invaluable resource during those planning processes. We are concerned that the explicit bare minimum step-wise approach previously promulgated by these authors, 4 and now reiterated once again, 1 will be interpreted as a de facto alternate set of lower standards by those in a position of power and used to endorse the current inadequacies in anesthesia services in many parts of the world. This would maintain the status quo in many lowand middle-income countries.…”