Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030.

Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.

Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report.

BACKGROUND: Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS: The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS: To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

Are Short Subspecialty Courses the Educational Answer?

There is an urgent need to train more anesthesia providers in low- and middle-income countries (LMICs). There is also a need to provide more educational opportunities in subspecialty areas of anesthetic practice such as trauma management, pain management, obstetric anesthesia, and pediatric anesthesia. Together, these subspecialty areas make up a large proportion of the clinical workload in LMICs. In these countries, the quality of education may be variable, there may be few teachers, and opportunities for continued learning and mentorship are rare. Short subspecialty courses such as Primary Trauma Care, Essential Pain Management, Safer Anaesthesia From Education-Obstetric Anaesthesia, and Safer Anaesthesia From Education-Paediatric Anaesthesia have been developed to help fill this need. They have the potential for immediate impact by providing an opportunity for continuing professional development and relevant subspecialty training. These courses are all short (1-3 days), are presented as an off-the-shelf package, and include a teach-the-teacher component. They use a variety of interactive teaching techniques and are designed to be adaptable and responsive to local needs. There is an emphasis on local ownership of the educational process that helps to promote sustainability. After an initial financial outlay to purchase equipment, the costs are relatively low. Short subspecialty courses appear to be part of the educational answer in LMICs, but there is a need for research to validate their role.

Eficacia del bloqueo caudal versus bloqueo subaracnoideo bajo sedación en el paciente pediátrico / Caudal against spinal block effcacy under sedation of the pediatric patient

Antecedentes: esta incrementado el uso de anestesia regional en pediatría, única o combinada con sedación ó anestesia general, para aumentar la analgesia postoperatoria, disminuir la utilización de fármacos sistémicos, los riesgos de la anestesia general y costos hospitalarios. Objetivo: determinar la eficacia de la analgesia quirúrgica y postoperatoria con bloqueo caudal versus el bloqueo subaracnoideo en pediatría. Materiales y Pacientes: Estudio descriptivo prospectivo, incluyendo 40 pacientes. Los criterios de inclusión fueron: edad de 1-15 años, indicación de cirugía en región inguinal y miembros inferiores, sexo indistinto, riesgos potencial al uso de anestesia general ASA I y II. Las variables para medir eficacia del procedimiento: analgesia quirúrgica, analgesia postoperatoria, recuperación del bloqueo motor, efectos secundarios y tipo de cirugía. Resultados: A 20 se les aplicó bloqueo caudal y a 20 bloqueo subaracnoideo. La eficacia de la analgesia quirúrgica en el bloqueo caudal fue en 16(80%) y en 20(100%) con subaracnoideo. La analgesia postoperatoria fue de 12-18 hrs en el bloqueo caudal y más de 24 hrs en el subaracnoideo. La recuperación inmediata del bloqueo motriz se presentó en los 20(100%) pacientes con bloqueo caudal y en 3(15%) con subaracnoideo. Ningún efecto secundario en el bloqueo caudal y con el bloqueo subaracnoideo 2(10%) presentaron náuseas y vómitos. En las cirugías ortopédicas el bloqueo caudal falló en 4(20%) y no se observaron fallas con el bloqueo subaracnoideo. Conclusión: Ambos bloqueos son eficaces para anestesia quirúrgica y seguros para el paciente pediátrico, pero en este grupo de pacientes el bloqueo subaracnoideo es más eficaz para la analgesia postoperatoria y para cirugía ortopédica...