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Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, or is conducted suboptimally. Currently, there are little data on the quality of newborn resuscitation in the context of a tertiary center in a lower–middle income country. We aimed to measure the competencies of clinical practitioners responsible for newborn resuscitation.

Two-thirds of the world’s population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Little is known concerning the incidence of anesthesia complications. Mercy Ships uses fully trained staff, and infrastructure and equipment resources similar to that of high-income countries, allowing the influence of these factors to be disentangled from patient factors when evaluating anesthesia and surgical outcomes after NGO sponsored surgery. We aimed to estimate the incidence of anesthesia-related and postoperative complications during a 2-year surgical mission in Madagascar.

A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda’s referral hospitals.

In the opinion of the World Federation of Societies of Anaesthesiologists (WFSA), the most important issue facing the global anesthesia community is the critical shortage of trained anesthesia providers in low- and middle-income countries (LMICs). This contributes to a global crisis where 5 of 7 billion people do not have access to safe surgical and anesthesia care when needed.1 Relatively few resources have been allocated to address the global anesthesia workforce crisis, and anesthesiologists must urgently innovate and lead on appropriate solutions.

Work stress is an integral part of anesthetic practice and has been a subject of many studies. Persistent stress can lead to burnout. There is limited published literature from lower- and middle-income countries where job stressors may be different from high-income countries. The aim of this study was to find out the level of burnout in a cohort of anesthesiologists working in academic institutions in 2 major cities of Pakistan, a low middle income country.

Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions.

Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone.

In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries.

It is unknown whether the implementation of an information video on spinal anesthesia for cesarean delivery, narrated in a patient’s first language, reduces anxiety, increases satisfaction, and improves doctor–patient communication if there is a language barrier. In South Africa, most doctors speak English, and patients speak Xhosa, with educational and cultural disparities existing in many doctor–patient interactions.

Only 20% of the surgical burden in eastern sub-Saharan Africa is currently met, leaving >17 million surgical cases annually in need of safe surgery and anesthesia. Similarly, there is an extreme shortage of anesthesia providers in East Africa, with just 0.44 anesthesiologists per 100,000 people in Kenya compared to 20.82 per 100,000 in the United States. Additionally, surgical access is not equally distributed within countries, with rural settings often having the greatest unmet need. We developed and tested a set of tools to assess if graduates of the Kenya registered nurse anesthetist (KRNA) training program, who were placed in rural hospitals in Kenya, would have any impact on surgical numbers, referral patterns, and economics of these hospitals.

Maternal mortality in low- and middle-income countries (LMICs) is higher than in high-income countries (HICs), and poor anesthesia care is a contributing factor. Many anesthesia complications are considered preventable with adequate training. The Safer Anaesthesia From Education Obstetric Anaesthesia (SAFE-OB) course was designed as a refresher course to upgrade the skills of anesthesia providers in low-income countries, but little is known about the long-term impact of the course on changes in practice. We report changes in practice at 4 and 12–18 months after SAFE-OB courses in Madagascar and the Republic of Congo.

Anesthesia & Analgesia and A&A Practice have opened up the following articles in support of the American Medical Women’s Association's Need Her Science Campaign to raise awareness about gender bias in journal publishing. We encourage you to share these articles on social media using #NeedHerScience and #IARS_Journals.

Posted in: ATOTW > Regional Anaesthesia 2019 Language: english

This tutorial will explore the currently published literature on erector spinae plane blocks and discover its versatility in regional anaesthesia.

On the pretext that they could be the best experts for their own medical follow-up, doctors prefer self-diagnosis and self-medication or, too often, seek a quick advice, “between two doors” … : Alas, sometimes, it’s too late ! This alarming fact led the SMART Commission of the CFAR (French College of Anesthetists and Intensivists ) to initiate a sustainable awareness campaign with all the Doctors practicing in France. The Campaign is also possible in Europe and elsewhere in the World. This unprecedented initiative brings together more than 33 institutional partners. In their own media, through social networks or through local initiatives, all have committed themselves to the sustainable dissemination of incentive messages carried by 12 campaign visuals. These visuals are representative of the diversity of professional paths and modes of exercise, private or public sectors.

Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.

There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients.

The link between health care worker fatigue and adverse events is well documented, with a substantial number of studies indicating that the practice of extended work hours contributes to high levels of worker fatigue and reduced productivity. These studies and others show that fatigue increases the risk of adverse events, compromises patient safety, and increases risk to personal safety and well-being. While it is acknowledged that many factors contribute to fatigue, including but not limited to insufficient staffing and excessive workloads, the purpose of this Sentinel Event Alert is to address the effects and risks of an extended work day and of cumulative days of extended work hours.

Health care professionals whose focus is on patient safety are very familiar with these alarming and frequently cited statistics from the Institute of Medicine: medical errors result in the death of between 44,000 and 98,000 patients every year. Health care professionals whose focus is on occupational health and safety, however, are likely aware of additional statistics that are less well known: health care workers experience some of the highest rates of nonfatal occupational illness and injury—exceeding even construction and manufacturing industries. This monograph is intended to stimulate greater awareness of the potential synergies between patient and worker health and safety activities. Using actual case studies, it describes a range of topic areas and settings in which opportunities exist to improve patient safety and worker health and safety activities. This monograph is designed to bridge safety-related concepts and topics that are often siloed within the specific disciplines of patient safety/quality improvement and occupational health and safety.

Posted in: Other > Anaesthesia 2019 Language: english

Standardization has long been accepted as a fundamental element of patient safety by the APSF and others. The International Organization for Standardization (ISO) was established in Geneva in February 1947 initially to help standardize industrial development. Since then the scope of ISO has expanded to cover, among many other matters, anesthesia apparatus. As the world becomes a smaller place with regard to the manufacture of such equipment, it is becoming commonplace for many components of anesthesia workstations to be manufactured with a global market in mind. This takes on greater significance as health care staff become increasingly able to move around the world to practice their specialites. It therefore seems even more appropriate in 2014 that all ISO standards should be adopted globally.

Posted in: Other > Safety 2019 Language: english

Statement on Off-label use of medicines by anaesthesiologists

Maternal mortality is high in many low- and middle-income countries. Unsafe anaesthesia contributes to this, especially for women requiring Caesarean section. Anaesthesia providers with limited skills and poor resources are often faced with complicated obstetric patients. A new course called SAFE-OB teaches a systematic approach to anticipating, preparing for, and dealing with obstetric anaesthetic emergencies. The course has now been taught in many African, Asian, and Latin countries. Initial follow-up suggests improvement in skills and knowledge, and effective translation of these to the workplace. Efforts are made to make the course locally owned and sustainable. We feel that SAFE-OB is an effective method of improving obstetric anaesthesia care.

Each year, millions of infants and toddlers require anesthesia and/or sedation for surgery, procedures, and tests. Concern has been raised about the safety of the medicines used for anesthesia and sedation in young children. This concern is based on research in animals demonstrating long-term, possibly permanent, injury to the developing brain caused by exposure to these medicines.This injury results in abnormalities in behavior, learning, and memory in animals. The effect of exposure to anesthetic drugs in young children is unknown; however, some but not all studies have suggested that problems similar to those seen in animals could also occur in infants and toddlers.

About the Library

WFSA's virtual library is a resource hub made up of our own publications and other open source material that we recommend for anaesthesia providers around the world. It contains a variety of media and can be searched according to keyword, publication and specialist category ensuring that the user finds the most relevant resource for their needs.

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The WFSA Virtual Library is for use by qualified anaesthesia providers and those pursuing a qualification in anaesthesia. Its content is supplementary to more formal education and is offered for informational purposes only. Whilst the WFSA has taken every care to ensure that content is accurate we can not be held responsible for any loss, damage or inconvenience caused as a result of any error or inaccuracy within the library.

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