Available online 20 November 2023, 151355

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The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2-4)

Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5-7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).

1

Improved perioperative care must include anaesthesia and nursing to improve perioperative outcomes for children.

2

Perioperative care for children in LMICs is predominantly by non-physician anaesthesia providers or non-specialty-trained anaesthesiologists.

3

There is a need to train physician anaesthesia leaders to direct and oversee the care of children undergoing anaesthesia

4

Infrastructure and equipment for the safe provision of paediatric anaesthesia/perioperative care are usually wanting/often times inadequate and inappropriate.

5

The GICS OReCS document provides a valuable guide for the bare minimum requirements for the provision of safe paediatric anaesthetic and surgical care services, starting at the district hospital.

6

Equipment donations should be conscientious, in consultation with local leads. Considerations will include biomedical support for maintenance, availability of spare parts, and electrical compatibility, among others.

7

Context-specific innovations have been shown to work in LMICs and include paediatric anaesthesia courses for all providers and simulation-based training using low technology.

8

Any worthwhile programs aimed at improving anaesthetic and surgical care for children need to ultimately fit into national healthcare systems.

Section snippetsAnaesthetic services

Well-developed perioperative care led by anesthesiologists contributes significantly to improved surgical outcomes in the perioperative period and the outcome of anaesthesia services. Of note here is that patient preparation directly affects outcomes such as fasting guidelines and aspiration, airway assessment and preparation for difficult airways, and preoperative haemoglobin, to name a few. Pain management has emerged as another area of great importance in the perioperative period,

Anesthesia Challenges

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Workforce- (Anesthesia, Nursing, Biomedical engineers)- Insufficiency in numbers and quality of training

1

Development of Leaders and Educators in Pediatric Anesthesia e.g. paediatric anaesthesia fellowship programs.

2

Standardisation of paediatric anaesthesia curriculums

3

Continuing professional development opportunities e.g. Short courses (SAFE PAEDS, MEPA)

4

Nursing Training

5

Team Training eg SAFE OR

6

Biomed Engineer Training

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Innovations

While there are many challenges to providing safe, good-quality perioperative care to children, particularly in resource-limited settings, several multicentre perioperative initiatives crossing varied income contexts show improved surgery safety without adding to the cost. Introducing the Surgical Safety Checklist and the Clean Cut programme to reduce perioperative infection are two initiatives that have positively affected outcomes in pediatric surgery.20,21

Innovations to address the human

Uncited References

2,3,4,5,6,7,8,9

Bibliography (23)L. CronjeA review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Southern African Journal of Anaesthesia and Analgesia

(2015)

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© 2023 Published by Elsevier Inc.