The safe practice of anesthesia in developing countries

Nurse anesthetists providing services in developing countries must be aware of the hazards inherent in such a mission. Proper planning and preparation are essential to insure safe, quality anesthesia care. Working conditions are austere; electrical supplies may be erratic, oxygen sources inconsistent, and up-to-date monitoring systems nonexistent. Medications and supplies will be limited, mandating conservation, reuse, and strict adherence to infection control procedures. Safe, reliable anesthesia delivery systems, preferably with the ability to scavenge waste anesthetics are required. Patients frequently have diseases endemic to the area and language barriers cause confusion and misunderstandings. The nurse anesthetist's role in these situations is multifaceted. This article describes how the nurse anesthetist must be creative, adaptable, and self-reliant to provide a high standard of anesthetic care and prevent mishaps in austere environments.