The Capnography Project.

Capnography is an essential tool used in the monitoring of patients during anesthesia and in critical care which, while required in most high-income countries, is unavailable in many low- and middle-income countries. Launched in 2020, the Smile Train-Lifebox Capnography Project aimed to find a "capnography solution" for resource-poor settings. The project was specifically interested in a capnography device that would meet the needs of the Smile Train partner hospitals to help monitor children requiring airway or cleft surgery. Project advisory and technical groups were formed and included representation from anesthesia practitioners from a balanced representation from all level of income countries, technical experts in capnography, and representatives from the Global Capnography Project (GCAP), the University of California at San Francisco Center for Health Equity in Surgery & Anesthesia (CHESA), and the World Federation of Societies of Anaesthesiologists (WFSA). Built upon the WFSA minimum capnometer specifications, a human centered design approach was used to develop a Target Product Profile. Seven manufacturers submitted 13 devices for consideration and 3 devices were selected for the testing phase. Each of these devices was evaluated for build quality, and clinical and usability performance. Based on the findings from the overall testing process, a combined capnography and pulse oximetry device by Zug Medical Systems was chosen. To accompany the new Smile Train-Lifebox capnograph, an international team of experienced anesthesiologists and educators came together to develop the necessary education materials. These materials were piloted in Ethiopia, subsequently modified, and endorsed by the education team. The device is now ready for distribution, with the accompanying education package, to the Smile Train network and beyond. In addition, a study is being planned to measure the impact of capnography introduction into operating rooms in resource-constrained settings.

Trabajando y enseñando en Chad / Working and teaching in Chad

Anesthesiologists from different centers of our country have been involved in an international cooperation program in Chad. this article shows the experience of a group of them, as well as a brief account of the work that different organizations have carried out to reduce the world wide deficit of anesthetists.

Anestesiólogos de distintos centros de nuestro país se han involucrado en un programa de cooperación internacional en Chad. este artículo muestra la experiencia de un grupo de ellos, así como un breve resumen del trabajo que distintas organizaciones han llevado a cabo para disminuir el déficit global de anestesistas.

Review article: safety aspects of anesthesia in under-resourced locations.

PURPOSE: Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world. PRINCIPAL FINDINGS: There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization's Surgical Safety Checklist could further reduce morbidity and mortality. CONCLUSIONS: Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.

Safe perioperative pediatric care around the world.

Pediatric anesthesia is no longer a small subspecialty, but an important sector where developments in the new century have brought effective and safe management to children in the perioperative period. Unfortunately, what is common daily practice in the high-income countries with all the guidelines, checklists, instruments, and dedicated pediatric anesthesiologists is often only a dream in the low- and middle-income countries where the basic anesthesia services for improving the high rate of morbidity and mortality still are lacking. Anesthesia given by nonphysicians, with no monitoring, lack of elementary supplies, poor control of infections and hemorrhage, and no water or electricity are very often the 'usual' conditions. The World Health Organization is working hard to offer teams, basic equipments, and teaching and what is needed to offer children of these countries the same opportunities given in the industrialized countries. Other projects such as the Lifebox Project have a similar aim. This paper outlines some of what organizations are doing around the world, with different strategies all having the same target: safe pediatric anesthesia.

Global operating theatre distribution and pulse oximetry supply: an estimation from reported data.

BACKGROUND: Surgery is an essential part of health care, but resources to ensure the availability of surgical services are often inadequate. We estimated the global distribution of operating theatres and quantified the availability of pulse oximetry, which is an essential monitoring device during surgery and a potential measure of operating theatre resources. METHODS: We calculated ratios of the number of operating theatres to hospital beds in seven geographical regions worldwide on the basis of profiles from 769 hospitals in 92 countries that participated in WHO's safe surgery saves lives initiative. We used hospital bed figures from 190 WHO member states to estimate the number of operating theatres per 100,000 people in 21 subregions throughout the world. To estimate availability of pulse oximetry, we sent surveys to anaesthesia providers in 72 countries selected to ensure a geographically and demographically diverse sample. A predictive regression model was used to estimate the pulse oximetry need for countries that did not provide data. FINDINGS: The estimated number of operating theatres ranged from 1·0 (95% CI 0·9-1·2) per 100,000 people in west sub-Saharan Africa to 25·1 (20·9-30·1) per 100,000 in eastern Europe. High-income subregions all averaged more than 14 per 100,000 people, whereas all low-income subregions, representing 2·2 billion people, had fewer than two theatres per 100,000. Pulse oximetry data from 54 countries suggested that around 77,700 (63,195-95,533) theatres worldwide (19·2% [15·2-23·9]) were not equipped with pulse oximeters. INTERPRETATION: Improvements in public-health strategies and monitoring are needed to reduce disparities for more than 2 billion people without adequate access to surgical care. FUNDING: WHO.

[World Federation of Societies of Anaesthesiologists (WFSA) - security in anaesthesia - worldwide]. / World Federation of Societies of Anaesthesiologists (WFSA) - Weltweit mehr Sicherheit in der Anästhesie.

In many countries of the world, standards of anaesthesiology are poor. Even the most modern equipment cannot be used properly without people who are able to work and deal with it. So education is a crucial requirement. Since 1955, the World Federation of Societies of Anaesthesiologists (WFSA) trains anaethesiologists worldwide to improve the standards of medicine in developing countries. The society works closely with WHO, ESA, FEEA and other international societies. Its aim: to make surgery safer throughout the world.

Anesthesia training in Rwanda.

BACKGROUND: In 2006 a program leading to a Master's degree in Anesthesia (MMed) was established in Rwanda as a joint venture between the National University of Rwanda (NUR), the Canadian Anesthesiologists' Society International Education Fund (CASIEF) and the American Society of Anesthesiologists Overseas Teaching Programme (ASAOTP). A MMed in Anesthesia is similar to a Fellowship in Canada and is common in many African countries. Most training programs are of three years duration. Rwanda has decided on a four-year program. PRINCIPAL FINDINGS: The background, organization and problems of the program are described. Challenges exist in recruiting residents and in developing an academic culture and evaluation system. Inadequate equipment and drug shortages limit the types of anesthesia provided. There is need for improvement in biomedical support. Volunteer Canadian and American anesthesiologists visit Rwanda to teach for a minimum period of one month. They instruct in the operating room and also in the classroom. While the focus of the program is on residents in anesthesia, the volunteers also teach the nurse anesthetists. The program has been in existence for only one year but progress has been made. The CASIEF will devote special attention to improving the management of pain. CONCLUSIONS: In time, it is hoped that Rwanda will become self-sufficient in training its own anesthesiologists and in retaining them to provide anesthesia services throughout the country. As anesthesia and surgery evolve, there will be a need for subspecialty training in anesthesia. It is hoped that, with continued assistance from the CASIEF and ASAOTP, the goal of the NUR will be achieved.