Abstract:
BACKGROUND:District-level hospitals (DLHs) are the main providers of surgical services for rural populations in Sub-Saharan Africa (SSA). Skilled teams are essential for surgical care, and gaps in anesthesia impact negatively on surgical capacity and outcomes. This study, from a baseline of a project scaling-up access to safe surgical and anesthesia care in Malawi, Tanzania, and Zambia, illustrates the deficit of anesthesia care in DLHs. METHODS:We undertook an in-depth investigation of anesthesia capacity in 76 DLHs across the 3 countries, July to November 2017, using a mixed-methods approach. The quantitative component assessed district-level anesthesia capacity using a standardized scoring system based on an adapted and extended Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) Index. The qualitative component involved semistructured interviews with providers from 33 DLHs, exploring how weaknesses in anesthesia impacted district surgical team practices and quality, volume, and scope of service provision. RESULTS:Anesthesia care at the district level in these countries is provided only by nonphysician anesthetists, some of whom have no formal training. Ketamine anesthesia is widely used in all hospitals, compensating for shortages of other forms of anesthesia. Pediatric size supplies/equipment were frequently missing. Anesthesia PIPES index scores in Malawi (M = 8.0), Zambia (M = 8.3), and Tanzania (M = 8.4) were similar (P = .59), but an analysis of individual PIPES components revealed important cross-country differences. Irregular availability of reliable equipment and supply is a particular priority in Malawi, where only 29% of facilities have uninterrupted access to electricity and 23% have constant access to water, among other challenges. Zambia is mostly affected by staffing shortages, with 30% of surveyed hospitals lacking an anesthesia provider. The challenge that stood out in Tanzania was nonavailability of functioning anesthesia machines among frequent shortages of staff and other equipment. CONCLUSIONS:Tanzania, Malawi, and Zambia are falling far short of ensuring universal access to safe and affordable surgical and anesthesia care for district and rural populations. Mixed-methods situation analyses, undertaken in collaboration with anesthesia specialists-measuring and understanding deficits in district hospital anesthetic staff, equipment, and supplies-are needed to address the critical neglect of anesthesia that is essential to providing surgical responses to the needs of rural populations in SSA.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Gajewski J,Pittalis C,Lavy C,Borgstein E,Bijlmakers L,Mwapasa G,Cheelo M,Le G,Juma A,Kachimba J,Marealle P,Mkandawire N,Chilonga K,Brugha Rdoi
10.1213/ANE.0000000000004363subject
Has Abstractpub_date
2020-04-01 00:00:00pages
845-853issue
4eissn
0003-2999issn
1526-7598journal_volume
130pub_type
杂志文章abstract:BACKGROUND:In clinical anesthesia, robust surgical stress occasionally causes unintended light anesthesia during operation. To test the hypothesis that neural input condition could modify actions of general anesthetics as a result of presynaptic alteration in the central nervous system, we investigated the mechanisms b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181dd25a5
更新日期:2010-06-01 00:00:00
abstract::Combinations of alpha 2 agonists and opiates are used in the clinical management of pain to harness their potential synergistic interaction for analgesia while limiting their side-effects. To better predict the clinical consequences of this combination, we studied the behavioral effects of dexmedetomidine, a highly se...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199609000-00030
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Recently, IA tramadol was also used for the management of these patients. However, the IA combination of local anesthetic and tramadol has not been evaluated in arthroscopic outpati...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31816ba364
更新日期:2008-07-01 00:00:00
abstract::We have determined that the mixed agonist-antagonist narcotic, butorphanol, improves CO2 response and ventilation after fentanyl anesthesia. A tentative dosage range has been established. Twenty-two patients were anesthetized with isoflurane, nitrous oxide, and fentanyl, which was continuously infused throughout the s...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1987-06-01 00:00:00
abstract:BACKGROUND:Red blood cell (RBC) transfusion is common during infant cardiac surgery. A previous report of pediatric heart transplant recipients showed that increased RBC transfusion volume was independently associated with increased length of intensive care unit stay. It is unclear whether transfusion to infants as a s...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001241
更新日期:2016-05-01 00:00:00
abstract::The cold pressor test is often used to assess vasoconstrictive responses because it simulates the vasoconstrictive challenges commonly encountered in the clinical setting. With IRB approval, 12 healthy volunteers, aged 25--50 yr, underwent baseline plethysmographic monitoring on the finger and ear. The contralateral h...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200106000-00026
更新日期:2001-06-01 00:00:00
abstract:UNLABELLED:In the present study, we assessed the potential effect of nitroglycerin IV (NTG), a donor of exogenous nitric oxide, on metabolic coronary flow control in patients with coronary artery disease. In 12 patients scheduled for coronary artery surgery, arterial blood pressure, pulmonary capillary wedge pressure, ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199902000-00009
更新日期:1999-02-01 00:00:00
abstract:UNLABELLED:We investigated halothane's effects on the function of L-type Ca2+ channels in a human neuronal cell line, SH-SY5Y, by using the cell-attached patch voltage clamp configuration and Ba2+ as the charge carrier. In multiple-channel patches, halothane decreased the peak and persistent Ba2+ currents, accelerated ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199804000-00038
更新日期:1998-04-01 00:00:00
abstract::This study was performed to compare the efficacy of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting (PONV) and to compare the possible adverse effects of these drugs in gynecologic incontinence surgery. Using a randomized, double-blind study design, we studied 150 women under...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199703000-00036
更新日期:1997-03-01 00:00:00
abstract::The potency of conventional inhaled anesthetics increases with increasing age: the 50% effective dose (minimum alveolar anesthetic concentration [MAC]) for anesthesia in the neonatal animal or human exceeds MAC in the young adult by approximately 30% to 60%. We tested whether this relationship also applies to the alka...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199704000-00028
更新日期:1997-04-01 00:00:00
abstract:BACKGROUND:Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318195e11d
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:The safety and adverse event rate of supraglottic airway (SGA) devices for cesarean delivery (CD) is poorly characterized. The primary aims of this review were to determine whether the first-pass success was higher and time to insertion for SGA was faster than endotracheal intubation for elective CD. The sec...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1213/ANE.0000000000004618
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Currently, the monitoring of cardiac output (CO) and stroke volume (SV) is mainly performed using invasive techniques. Therefore, performing CO monitoring noninvasively by means of electrical impedance tomography (EIT) would be advantageous for intensive care. Our hypothesis was that, by means of EIT, it is ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000241
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:The incidence and implications of anti-heparin-platelet factor 4 (PF4) antibody seroconversion in the pediatric cardiac surgical population remain largely unexplored. We sought to prospectively characterize the incidence of seroconversion in two populations: neonates undergoing primary cardiac surgery and ch...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181734604
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:As orexinergic (OXergic) neurons have been reported to mediate emotional changes, benzodiazepines might interact with OXergic neurons. METHODS:We examined the interactions between OXergic neurons and benzodiazepine receptors in orexin-A (100 nM) and K+ (25 mM)-evoked norepinephrine release from rat cerebroc...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000252413.62821.2e
更新日期:2007-02-01 00:00:00
abstract::In addition to offering further data on the exposure of surgical and recovery-room personnel to low levels of halothane in room air, the authors demonstrate the presence of halothane levels in the blood of some surgical patients managed by other inhalation agents from machines previously used for halothane. The author...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197507000-00010
更新日期:1975-07-01 00:00:00
abstract:BACKGROUND:Several data suggest that both opioid and N-methyl-d-aspartate (NMDA) receptors are localized at the peripheral level, and drugs acting on these receptors may produce antinociception after topical administration; however, the antinociceptive effect of endogenous ligands at these receptors is poorly clarified...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181b21c5e
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemas...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003678
更新日期:2018-10-01 00:00:00
abstract:UNLABELLED:We sought to determine whether acute experimental allergic encephalomyelitis (EAE) alters the incorporation of epidurally administered [(3)H]-D-mannitol and [(14)C]-carboxyl-inulin into the lumbar spinal cord in rabbits. Acute EAE is an experimental model for demyelinating spinal cord diseases such as multip...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200201000-00040
更新日期:2002-01-01 00:00:00
abstract:UNLABELLED:In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was app...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199808000-00032
更新日期:1998-08-01 00:00:00
abstract:IMPLICATIONS:Manipulating the density of local anesthetic solutions by using a simple formula may be clinically useful in producing optimal density solutions for spinal anesthesia under a variety of clinical conditions. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200206000-00048
更新日期:2002-06-01 00:00:00
abstract::Neuraxial anesthesia may improve perioperative outcomes when compared to general anesthesia; however, this is controversial. We performed a systematic review and meta-analysis using randomized controlled trials and population-based observational studies identified in MEDLINE, PubMed, and EMBASE from 2010 to May 31, 20...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析,评审
doi:10.1213/ANE.0000000000002069
更新日期:2017-12-01 00:00:00
abstract:UNLABELLED:Encouraged by the popularity of the pulse oximeter pulse-tone, we developed and tested an auditory display of six physiologic variables. The display consisted of a cardiovascular sound triggered by every heartbeat (conveying heart rate) and a respiratory sound triggered by every breath (conveying respiratory...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200202000-00025
更新日期:2002-02-01 00:00:00
abstract::A 6-year experience in the anesthetic management of 34 successful whole-lung lavages on 11 adult patients with pulmonary alveolar proteinosis is described. All patients were radiographically, physiologically, and symptomatically improved after the procedures. The anesthetic protocol for lung lavage includes: (1) unila...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197709000-00012
更新日期:1977-09-01 00:00:00
abstract:BACKGROUND:Sigma (sigma)-receptor agonists attenuate brain injury after experimental focal cerebral ischemia in several species. We tested the hypothesis that the potent, prototypical sigma(1)-receptor agonist, 4-phenyl-1-(4-phenylbutyl) piperidine (PPBP), protects neurons by a mechanism involving the antiapoptotic pro...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000260267.71185.73
更新日期:2007-05-01 00:00:00
abstract::Tranexamic acid (TA) is a synthetic drug that inhibits fibrinolysis. It has been administered to decrease the use of blood products during cardiac surgery and orthotopic liver transplantation when infused in larger doses. A small-dose infusion of aprotinin causes a reduction in fibrinolysis and blood product requireme...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199708000-00007
更新日期:1997-08-01 00:00:00
abstract::Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard vid...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182410cbf
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster. METHODS:We performed an observational, prospective study of consecutive patient...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000253523.80050.e9
更新日期:2007-03-01 00:00:00
abstract::To evaluate the effects of acute sympathetic denervation on the baroreflex control of heart rate, baroreflex sensitivities were compared in lightly anesthetized humans who had either cervical (N = 20) or lumbar epidural anesthesia (N = 18), or neither (N = 18). Levels of anesthesia during cervical block using 10 ml of...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract:BACKGROUND:The cerebral perfusion pressure that denotes the lower limit of cerebral blood flow autoregulation (LLA) is generally considered to be equivalent for reductions in arterial blood pressure (ABP) or increases in intracranial pressure (ICP). However, the effect of decreasing ABP at different levels of ICP has n...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181964848
更新日期:2009-04-01 00:00:00