Assessing Pediatric Anesthesia Practices for Volunteer Medical Services Abroad

2001 ◽  
Vol 95 (6) ◽  
pp. 1315-1322 ◽  
Author(s):  
Quentin A. Fisher ◽  
David Nichols ◽  
Frank C. Stewart ◽  
G. Allen Finley ◽  
William P. Magee ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Ventilatory Support ◽  
Pediatric Anesthesia ◽  
Developed Countries ◽  
Medical Services ◽  
Postanesthesia Care Unit ◽  
Anesthetic Techniques ◽  
Medical Teams ◽  
The Developed Countries

Background Anesthetic techniques and problems in volunteer medical services abroad are different from those of either the developed countries from which volunteers originate or the host country in which they serve because of differences in patient population, facilities, and goals for elective surgery. Assessing outcomes is hampered by the transience of medical teams and the global dispersion of providers. We studied general anesthesia techniques and outcomes in a large international voluntary surgical program. Methods Anesthesia providers and nurses participating in care of patients undergoing reconstructive plastic and orthopedic surgery by Operation Smile over an 18-month period were asked to complete a quality assurance data record for each case. Incomplete data were supplemented by reviewing the original patient records. Results General anesthesia was used in 87.1% of the 6,037 cases reviewed. The median age was 5 yr (25th-75th percentiles: 2-9 yr). Orofacial clefts accounted for more than 80% of procedures. Halothane mask induction was performed in 85.6% of patients; 96.3% of patients had tracheal intubation, which was facilitated with a muscle relaxant in 19.3%. Respiratory complications occurred during anesthesia in 5.0% of patients and during recovery (postanesthesia care unit) in 3.3%. Arrhythmias requiring therapy occurred in 1.5%, including three patients to whom cardiopulmonary resuscitation was administered. Prolonged ventilatory support was required in seven patients. There was one death. Inadvertent extubation during surgery occurred in 38 patients. Cancellation of surgery after induction of anesthesia occurred in 25 patients. Overall, complications were more common in younger children. Conclusions Our study showed that in this setting it is feasible to track anesthesia practice patterns and adverse perioperative events. We identified issues for further examination.

The Growth of Medical Tourism

2015 ◽  
pp. 365-378
Author(s):  
Jerry Eades
Keyword(s):  
Medical Tourism ◽  
Developed Countries ◽  
Global Market ◽  
Tourism Industry ◽  
Medical Services ◽  
Medical Practitioners ◽  
Travel Agents ◽  
Massive Growth ◽  
Wellness Tourism ◽  
The Developed Countries

In the late 2000s, the author wrote a summary paper on the rise of medical tourism. That paper discussed the rapid growth of interest in medical, health and wellness tourism, especially since 2003. The medical tourism industry has a long history, but this massive growth is a new phenomenon. The important factors are: the changing distribution of medical services and technologies; the growth of interest among both local medical practitioners and travel agents; the packaging of tourism and medical services as a single product; and, most significantly, the availability of the Internet to disseminate information them, creating a global market. The present chapter considers first the burgeoning literature on medical tourism. Second, the processes of development in countries becoming the main players in the international provision of medical services are discussed. Third, the chapter looks at the debates surrounding the rise of medical tourism in the developed countries.

scholarly journals Peripheral nerve blocks in pediatric anesthesia

2009 ◽  
Vol 137 (9-10) ◽  
pp. 497-501
Author(s):  
Dejan Novakovic ◽  
Ivana Budic ◽  
Dusica Simic ◽  
Nina Djordjevic ◽  
Andjelka Slavkovic ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
General Anesthesia ◽  
Age Groups ◽  
Pediatric Anesthesia ◽  
Anesthetic Techniques ◽  
Older Children ◽  
Nerve Blocks ◽  
Patient Age ◽  
Peripheral Nerve Blocks ◽  
Patient Âgé

Introduction Most children undergoing surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with general anesthesia. The use of peripheral nerve blocks (PNBs) in pediatric anesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. Objective This article discusses a general approach to PNBs in children and provides data concerning the practice of this regional technique in different age groups. Methods Data from 1,650 procedures were prospectively collected during the period from March 1, 2007 to February 29, 2008. The type of PNB, if any, as well as the patient age were noted. Our patients were divided into four groups: 0-3 years, 4-7 years, 8-12 years and 13-18 years. Results During the investigated period, PNBs as a sole technique or in anesthetized children were performed in 7.45% of cases. Ilioingunal/iliohypogastric nerve block and penile block were the most common (70% of all PNBs) distributed mainly among the children between 4-7 years of age (p<0.05). In older children, extremity PNBs predominate in regard to other types of blocks. PNBs are most frequently performed under general anesthesia (85%), so the perineural approach requires a safe technique to avoid nerve damage. Conclusion The observed differences in PNB usage seem to be related to patient age and correlate with common pathology and also with technical availability of PNB performance.

Perioperative Cost-finding Analysis of the Routine Use of Intraoperative Forced-air Warming during General Anesthesia 

1998 ◽  
Vol 88 (5) ◽  
pp. 1357-1364 ◽  
Author(s):  
Lee A. Fleisher ◽  
Scott E. Metzger ◽  
Janet Lam ◽  
Andrew Harris
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Perioperative Complications ◽  
Tracheal Extubation ◽  
Postanesthesia Care Unit ◽  
Thermal Care ◽  
Institutional Review ◽  
Forced Air Warming ◽  
Finding Study ◽  
Forced Air

Background Despite the well-documented ability of forced-air warming (FAW) to maintain normothermia, it is unclear whether this technique results in a net increase or decrease in costs. The authors did a prospective cost-finding study comparing FAW with routine thermal care in patients at low risk for perioperative complications who were undergoing general anesthesia. Methods After institutional review board approval was received, 100 patients were studied who were having elective surgery scheduled for more than 2 h during general endotracheal anesthesia. Patients were randomly assigned to one of two groups: FAW or routine thermal care. All patients received a standardized anesthetic. Anesthesia providers were blinded to core temperatures and the use of FAW. Primary outcomes were those associated with perioperative costs. Results The time from completion of surgical dressing until tracheal extubation was significantly reduced in the FAW group (10 +/- 1 min compared with 14 +/- 1 min; mean +/- SEM; P &lt; 0.01). There was no demonstrable difference in attainment of postanesthesia care unit discharge criteria between the two groups, although the FAW group used one less cotton blanket there. The net savings related to the use of the FAW depends on the percentage of the intraoperative costs that are fixed rather than variable ($15 additional for FAW if all costs are fixed compared with $29 savings if all costs were variable). Conclusions Routine intraoperative FAW significantly reduced time until extubation and use of cotton blankets in the postanesthesia care unit. These results suggest that the influence of FAW on net total perioperative costs depends on patient and surgical characteristics and institutional factors related to cost accounting.

THE CHILD'S LOSS OF CONSCIOUSNESS: A PSYCHIATRIC VIEW OF PEDIATRIC ANESTHESIA

PEDIATRICS ◽  
1972 ◽  
Vol 50 (2) ◽  
pp. 252-263
Author(s):  
Albert Bothe ◽  
Richard Galdston
Keyword(s):  
General Anesthesia ◽  
Psychological Stress ◽  
Ego Development ◽  
Pediatric Patients ◽  
Elective Surgery ◽  
Pediatric Anesthesia ◽  
Loss Of Consciousness ◽  
Frequency Of Occurrence ◽  
Anesthetic Induction ◽  
Before And After

Fifty healthy pediatric patients receiving general anesthesia for minor elective surgery were studied to assess how children experience and conceptualize induced unconsciousness. The techniques used by the patients and staff to minimize the psychological stress of anesthesia were observed. The findings confirm previous studies of the incidence of agitated behavior before and after anesthesia and suggest methods to decrease the frequency of occurrence. Behavioral signs predictive of agitation during anesthetic induction or emergence are discussed. The theoretical implications of these observations are related to ego development and to the capacity of the child to tolerate stress.

Awareness during Anesthesia 

1999 ◽  
Vol 90 (4) ◽  
pp. 1053-1061 ◽  
Author(s):  
Karen B. Domino ◽  
Karen L. Posner ◽  
Robert A. Caplan ◽  
Frederick W. Cheney
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Anesthetic Techniques ◽  
Post Traumatic Stress ◽  
Intraoperative Awareness ◽  
Malpractice Claims ◽  
Depth Analysis ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. Methods The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Results Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P &lt; 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Conclusions Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

How to Assure Stable Development in Unstable Financial Environment?

2007 ◽  
pp. 4-26 ◽  
Author(s):  
M. Ershov
Keyword(s):  
Stock Market ◽  
Developed Countries ◽  
Market Liquidity ◽  
Market Mechanisms ◽  
Russian Economy ◽  
The Developed Countries ◽  
Russian Stock Market ◽  
Stable Development ◽  
Financial Environment

Growing involvement of Russian economy in international economic sphere increases the role of external risks. Financial problems which the developed countries are encountered with today result in volatility of Russian stock market, liquidity problems for banks, unstable prices. These factors in total may put longer-term prospects of economic growth in jeopardy. Monetary, foreign exchange and stock market mechanisms become the centerpiece of economic policy approaches which should provide for stable development in the shaky environment.

The Reproduction Vector of the Russian Economy: 1999-2007

2008 ◽  
pp. 94-109 ◽  
Author(s):  
D. Sorokin
Keyword(s):  
Economic Policy ◽  
Human Capital ◽  
Growth Rates ◽  
Developed Countries ◽  
Gdp Per Capita ◽  
Real Sector ◽  
Russian Economy ◽  
Per Capita ◽  
The Developed Countries

The problem of the Russian economy’s growth rates is considered in the article in the context of Russia’s backwardness regarding GDP per capita in comparison with the developed countries. The author stresses the urgency of modernization of the real sector of the economy and the recovery of the country’s human capital. For reaching these goals short- or mid-term programs are not sufficient. Economic policy needs a long-term (15-20 years) strategy, otherwise Russia will be condemned to economic inertia and multiplying structural disproportions.

Power Generation for India with Higher Efficiency

2018 ◽  
Vol 6 (7) ◽  
pp. 267
Author(s):  
Umeshkannan P ◽  
Muthurajan KG
Keyword(s):  
Power Generation ◽  
Objective Function ◽  
Fossil Fuels ◽  
Programming Model ◽  
Developed Countries ◽  
Power Requirement ◽  
Average Efficiency ◽  
Potential Demand ◽  
The Developed Countries ◽  
Developed Nations

The developed countries are consuming more amount of energy in all forms including electricity continuously with advanced technologies.  Developing  nation’s  energy usage trend rises quickly but very less in comparison with their population and  their  method of generating power is not  seems  to  be  as  advanced  as  developed  nations. The   objective   function   of   this   linear   programming model is to maximize the average efficiency of power generation inIndia for 2020 by giving preference to energy efficient technologies. This model is subjected to various constraints like potential, demand, running cost and Hydrogen / Carbon ratio, isolated load, emission and already installed capacities. Tora package is used to solve this linear program. Coal,  Gas,  Hydro  and  Nuclear  sources can are  supply around 87 %  of  power  requirement .  It’s concluded that we can produce power  at  overall  efficiency  of  37%  while  meeting  a  huge demand  of  13,00,000  GWh  of  electricity.  The objective function shows the scenario of highaverage efficiency with presence of 9% renewables. Maximum value   is   restricted   by   low   renewable   source’s efficiencies, emission constraints on fossil fuels and cost restriction on some of efficient technologies. This    model    shows    that    maximum    18%    of    total requirement   can   be   met   by   renewable itself which reduces average efficiency to 35.8%.   Improving technologies  of  renewable  sources  and  necessary  capacity addition  to  them in  regular  interval  will  enhance  their  role and existence against fossil fuels in future. The work involves conceptualizing, modeling, gathering information for data’s to be used in model for problem solving and presenting different scenarios for same objective.

International Economic Assistance in the 1970's — A Critique of Partners in Development (Review Article)

1970 ◽  
Vol 10 (4) ◽  
pp. 469-490
Author(s):  
Nurul Islam
Keyword(s):  
Developing Countries ◽  
Foreign Aid ◽  
International Aid ◽  
Developed Countries ◽  
Armed Conflicts ◽  
Economic Assistance ◽  
Self Help ◽  
Service Charge ◽  
The Developed Countries ◽  
Defence Expenditure

Foreign economic aid is at the cross-roads. There is an atmosphere of gloom and disenchantment surrounding international aid in both the developed and developing countries — more so in the former than in the latter. Doubts have grown in the developed countries, especially among the conservatives in these countries, as to the effectiveness of aid in promoting economic development, the wastes and inefficiency involved in the use of aid, the adequacy of self-help on the part of the recipient countries in husbanding and mobilising their own resources for development and the dangers of getting involved, through ex¬tensive foreign-aid operations, in military or diplomatic conflicts. The waning of confidence on the part of the donors in the rationale of foreign aid has been accentuated by an increasing concern with their domestic problems as well as by the occurrence of armed conflicts among the poor, aid-recipient countries strengthened by substantial defence expenditure that diverts resources away from development. The disenchantment on the part of the recipient countries is, on the other hand, associated with the inadequacy of aid, the stop-go nature of its flow in many cases, and the intrusion of noneconomic considerations governing the allocation of aid amongst the recipient countries. There is a reaction in the developing countries against the dependence, political and eco¬nomic, which heavy reliance on foreign aid generates. The threat of the in¬creasing burden of debt-service charge haunts the developing world and brings them back to the donors for renewed assistance and/or debt rescheduling.

PENGARUH INFRASTRUKTUR SECARA SPASIAL TERHADAP KONVERGENSI PERTUMBUHAN EKONOMI DI INDONESIA

INFO ARTHA ◽  
2017 ◽  
Vol 1 ◽  
pp. 17-28
Author(s):  
Anisa Fahmi
Keyword(s):  
Economic Growth ◽  
Regional Economics ◽  
Developed Countries ◽  
Road Infrastructure ◽  
Long Run ◽  
Catch Up ◽  
The Developed Countries ◽  
Positive Effect ◽  
Neoclassical Growth Theory

Motivated by inter-regional disparities condition that occurs persistently, this study examines the Indonesian economy in the long run in order to know whether it tends to converge or diverge. This convergence is based on the Solow Neoclassical growth theory assuming the existence of diminishing returns to capital so that when the developed countries reach steady state conditions, developing countries will continuously grow up to 'catch-up' with developed countries. Based on regional economics perspective, each region can not be treated as a stand-alone unit,therefore, this study also focuses on the influence of spatial dependency and infrastructure. Economical and political situations of a region will influence policy in that region which will also have an impact to the neighboring regions. The estimation results of spatial cross-regressive model using fixed effect method consistently confirmed that the Indonesian economy in the long term will likely converge with a speed of 8.08 percent per year. Other findings are road infrastructure has a positive effect on economic growth and investment and road infrastructure are spatially showed a positive effect on economic growth. In other words, the investment and infrastructure of a region does not only affect the economic growth of that region but also to the economy of the contiguous regions. 

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