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- Title
Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low- and Middle-Income Countries.
- Authors
Powell Jr, William Francis; Echeto-Cerrato, Maria Alejandra; Gathuya, Zipporah; Gray, Rebecca Mary; Hodges, Sarah; Nabukenya, Mary T.; Newton, Mark W.; Rai, Ekta; Evans, Faye M.
- Abstract
Background: Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low- and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed. Methods: A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions. Results and conclusions: There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, large-scale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.
- Subjects
PEDIATRIC therapy; MIDDLE-income countries; OPERATING room nursing; PEDIATRIC anesthesia; LITERATURE reviews; ANESTHESIOLOGISTS; CHILD patients
- Publication
World Journal of Surgery, 2023, Vol 47, Issue 12, p3429
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-023-07229-5