Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings

Global Anesthesia Workforce Crisis: A Preliminary Survey Revealing Shortages Contributing to Undesirable Outcomes and Unsafe Practices

BACKGROUND. The burden of disease, disability, and mortality that could be averted by surgery is growing. However, few low and middle income countries (LMICs) have the infrastructure or capacity to provide surgical services to meet this growing need. Equally, few of these countries have been assessed for key infrastructural capacity including surgical and anesthesia providers, equipment, and supplies. These assessments are critical to revealing magnitude of the evolving surgical and anesthesia workforce crisis, related morbidity and mortality, and necessary steps to mitigate the impact of the crisis. METHODS. A pilot Internet-based survey was conducted to estimate per-capita anesthesia providers in LMICs. Information was obtained from e-mail respondents at national health care addresses, and from individuals working in-country on anesthesia-related projects. RESULTS. Workers from 6 of 98 countries responded to direct e-mail inquiries, and an additional five responses came from individuals who were working or had worked in-country at the time of the survey. The data collected revealed that the per-capita anesthesia provider ratio in the countries surveyed was often 100 times lower than in developed countries. CONCLUSIONS. This pilot study revealed that the number of anesthesia providers available per capita of population is markedly reduced in low and lower middle income countries compared to developed countries. As anesthesia providers are an integral part of the delivery of safe and effective surgical care, it is essential that more data is collected to fully understand the deficiencies in workforce and capacity in low and middle income countries

Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services

Broken needle during spinal anesthesia: an avoidable complication

Rawéléguinbasba Armel Flavien Kabore,1 Ibrahim Alain Traore,2 Salah Idriss Séif Traore,3 Cheik Tidiane Hafi Wind-Pouiré Bougouma,1 Pascal Augustin,4 Aboudoul-Fataou Ouro-Bang’na Maman5 1Department of Anesthesia, University Hospital Blaise Comparoé, Ouagadougou, Burkina Faso; 2Department of Anesthesia, Uiversity Hospital Sourou Sanou, Bobo Dioulasso, Burkina Faso; 3Department of Anesthesia, District Hospital of Bogodogo, Ouagadougou, Burkina Faso; 4Department of Anesthesia, Intercommunity Hospital of Meulan, Les Mureaux, Meulan en Yvelines, France; 5Department of Anesthesia, Ales-en-Cévennes Hospital, Alès-en-Cévennes, France Abstract: The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication. Keywords: spinal anesthesia, needle breaking, cesarean section, obesit

Pratique du bloc axillaire au CHU Sylvanus Olympio de Lome (Togo)

Objectif: Pratique du bloc axillaire au CHU Sylvanus Olympio de Lomé (Togo)Matériel et Méthodes: Etude rétro-prospective réalisée de du 1er Novembre 2009 au 31 Octobre 2010. Après accord du comité éthique de l’hôpital, les données démographiques et médicales, le type de chirurgie, le protocole anesthésique, les incidents et accidents per opératoires et l’analgésie post opératoire ont été précisés.Résultats: 75 patients ayant bénéficiés du bloc axillaire ont été retenus. L’âge moyen des patients était de 43 ± 26 ans. Il y avait une prédominance masculine dans 70,67% des cas avec une sex-ratio de 2,41. Dans 90% des cas, il s’agissait d’une chirurgie programmée. La chirurgie orthopédique et traumatologique était pratiquée dans 53,33% des cas. 54,67% des patients ont été classés ASAI, 34,66% ASAII et 10,67% ASAIII. Seuls 15 patients ont bénéficiés d’une pré induction au Fentanyl et 3 patients au Diazépam. Le bloc axillaire était réalisé avec succès chez dans 73,33% des cas. Il y a eu 3 cas d’hypotension artérielle et 1 cas de bradycardie en per opératoire. L’analgésie post opératoire a été réalisée par du Paracétamol, du Néfopam associés aux AINS et parfois de la titration morphinique.Conclusion: le bloc axillaire reste une technique d’anesthésie loco régionale peu pratiquée chez nous malgré ses nombreux avantages.Mots clés: Anesthésie loco régionale, bloc axillaire, TogoEnglish AbstractObjective: Practice of axillary block at Sylvanus Olympio Teaching Hospital Lome (Togo).Material and Methods: Study carried out retro-prospective 1 November 2009 to October 31, 2010. After approval of the ethics committee of the hospital, medical and demographic data, type of surgery, the anesthetic protocol, incidents and accidents intraoperative and postoperative analgesia were identified.Results: 75 patients undergoing axillary block were selected. The average age of patients was 43 ± 26 years. There was a male predominance in 70.67% of cases with a sex ratio of 2.41. In 90% of cases, this was a planned surgery. The orthopedic and trauma surgery was performed in 53.33% of cases. 54.67% of patients were classified ASAI, 34.66% ASAII and 10.67% ASAIII. Only 15 patients had pre induction of fentanyl and diazepam in 3 patients. The axillary block was performed successfully in 73.33% of cases. There were 3 cases of hypotension and bradycardia during surgery. Postoperative analgesia was performed by the Paracetamol, Nefopam associated with NSAID and sometimes Morphine titration.Conclusion: The axillary block is a technique of regional anesthesia little used in our context despite its many advantages.Mots clés: Loco régional anaesthesia, axillary block, Tog

Anesthésie péridurale pour ostéosynthèses du fémur et du tibia chez une femme enceinte

The regional anesthesia seems an interesting alternative for pregnant women because of the risk of general anesthesia in this field. A pregnant woman of 30 years to 29 weeks gestation received a fixation of the femur and tibia in a time under epidural anesthesia after multidisciplinary analysis. An unstable blood pressure was under control during surgery, no complications occurred after surgery.Keywords: Epidural Anesthesia, pregnancy, orthopedic and trauma surgeryJ. Rech. Sci. Univ. Lomé (Togo), 2012, Série D, 14(2) : 47-4