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Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low- and
William Francis Powell1, Maria Alejandra Echeto-Cerrato2, Zipporah Gathuya3
1Department of Anesthesiology, Harvard Medical School, Mass Eye and Ear243 Charles Street, Boston, MA, 02114, USA. william.powell.jr@gmail.com.
Insights
Pediatric perioperative mortality remains high in low- and middle-income countries (LMICs) due to shortages in trained providers, essential equipment, and infrastructure. Addressing these disparities requires global collaboration and targeted interventions to improve child surgical safety.
Area of Science:
- Global Health
- Pediatric Anesthesia
- Surgical Outcomes
Background:
- Significant disparities exist in pediatric perioperative mortality between high-income countries (HICs) and low- and middle-income countries (LMICs).
- Despite studied cohorts being low-risk, pediatric mortality rates are disproportionately higher in LMICs.
- These disparities necessitate urgent study and intervention to improve global child surgical care.
Approach:
- A narrative literature review was conducted to identify factors contributing to pediatric perioperative outcome disparities.
- The review explored existing knowledge gaps and interventions aimed at mitigating these differences.
- Recommendations for future research and practice were formulated.
Key Points:
- Shortages of trained pediatric anesthesia providers in LMICs are a critical barrier.
- Lack of essential pediatric-specific medications, equipment, and infrastructure hinders safe perioperative care.
- Inadequate preparedness of perioperative staff for emergencies, potentially addressed by simulation training.
Conclusions:
- Global initiatives like the World Federation of Societies of Anaesthesiologists (WFSA) are developing standards and educational resources.
- Short-term educational courses and online tutorials are being implemented in LMICs.
- Ongoing data collection in Africa aims to better understand pediatric perioperative outcomes, but further efforts are crucial.
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.
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