scholarly journals The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

2020 ◽  
Author(s):  
Kun-ming Tao ◽  
Sann Sokha ◽  
Hong-bin Yuan
Keyword(s):  
Developing Countries ◽  
Assessment Tool ◽  
Medical Center ◽  
International Standards ◽  
World Health ◽  
World Federation ◽  
Anesthetic Techniques ◽  
Safe Practice ◽  
Anesthesia Practice ◽  
The World

Abstract Background : The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. Methods : We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA. Results: A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations. Conclusions : This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.

scholarly journals The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

2019 ◽  
Author(s):  
Kun-ming Tao ◽  
Sann Sokha ◽  
Hong-bin Yuan
Keyword(s):  
Developing Countries ◽  
Assessment Tool ◽  
Medical Center ◽  
International Standards ◽  
World Health ◽  
World Federation ◽  
Anesthetic Techniques ◽  
Safe Practice ◽  
Anesthesia Practice ◽  
The World

Abstract Background: The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It is a good assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. Methods: We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA. Results: A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations. Conclusions: This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.

scholarly journals The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

2020 ◽  
Author(s):  
Kun-ming Tao ◽  
Sann Sokha ◽  
Hong-bin Yuan
Keyword(s):  
Developing Countries ◽  
Assessment Tool ◽  
Medical Center ◽  
International Standards ◽  
World Health ◽  
World Federation ◽  
Anesthetic Techniques ◽  
Safe Practice ◽  
Anesthesia Practice ◽  
The World

Abstract Background: The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA.Methods: We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA.Results: A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations.Conclusions: This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.

scholarly journals Anesthesia safety standards for operating rooms of small hospitals and surgery clinics

2020 ◽  
Vol 63 (9) ◽  
pp. 514-517
Author(s):  
Yong-Hee Park ◽  
Tae-Yop Kim
Keyword(s):  
Surgical Care ◽  
Operating Rooms ◽  
International Standards ◽  
World Health ◽  
Morbidity Rate ◽  
World Federation ◽  
Health Coverage ◽  
Safety Standards ◽  
Anesthesia Safety ◽  
The World

Access to surgical care and essential anesthesia is an integral part of universal health coverage. Also, increasing access to surgical care depends on a parallel increase in access to safe anesthesia. Today, five billion people (more than two-thirds of the world’s population) still do not have adequate, quality surgery and anesthesia care at the right time. Therefore, the World Federation of Societies of Anesthesiologists and the World Health Organization developed the International Standards for Safe Practice of Anesthesia. The standards include the following components, which are essential for the safety of patients undergoing surgical procedures: professional expertise, facilities and equipment, medications and intravenous fluids, monitoring, and anesthesia. In this article, it is emphasized that wherever and whenever possible, anesthesia should be provided, led, or overseen by an anesthesiologist. It is also strongly recommended that essential equipment is in place and adequate training to handle it safely has been provided. Unfortunately, some operating rooms of small hospitals and clinics does not meet the above standards. It may be difficult for each hospital to manage autonomously due to the lack of a unified checklist for essential standardized requirements. By introducing appropriate anesthesia safety standards in the operating rooms of small hospitals and surgery clinics, it will be possible to increase patient safety during surgery performed under general anesthesia, deep sedation, moderate sedation, or regional anesthesia. Through this process, it is expected that the mortality and morbidity rate of unexpected surgery patients can be minimized.

Hazards in anaesthetic practice: body systems and occupational hazards

2017 ◽  
Author(s):  
Alan F. Merry ◽  
Simon J. Mitchell ◽  
Jonathan G. Hardman
Keyword(s):  
Postoperative Cognitive Dysfunction ◽  
International Standards ◽  
High Rate ◽  
World Health ◽  
World Federation ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Health Organization ◽  
Rate Of Failure

“Can’t intubate, can’t oxygenate” crises and aspiration of gastric contents are important hazards in anaesthesia, and may result in the death of relatively young and healthy patients. Airway difficulties may manifest at the end of anaesthesia as well as at induction and are commoner in emergency departments and intensive care settings than during anaesthesia in operating rooms. Elements of poor management characterize the majority of airway complications. Emergency cricothyroidotomy performed by anaesthetists is associated with a high rate of failure. Other important hazards associated with anaesthesia may involve excessive or inadequate levels of oxygen or carbon dioxide in the blood, hypertension or hypotension, hypothermia or hyperthermia (including malignant hyperpyrexia), hypovolaemia, embolism of gas or thrombus, awareness, infection, and injury to the peripheral or central nervous system, or the eyes. Stroke and postoperative cognitive dysfunction may be particularly devastating for patients. These hazards are typically increased in low- and middle-income countries. The World Federation of Societies of Anaesthesiologists and the World Health Organization have endorsed international standards for a safe practice of anaesthesia, which are structured to reflect different levels of resource. The Lifebox Foundation seeks to improve the safety of surgery and anaesthesia in resource-constrained areas, notably by closing the substantial global gap in pulse oximetry. Several hazards are integral to the occupation of anaesthesia, including certain infections, increased rates of suicide, and medico-legal risks. In the end, the best way to mitigate these risks is through focusing on the safety of our patients.

scholarly journals World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

2018 ◽  
Vol 126 (6) ◽  
pp. 2047-2055 ◽  
Author(s):  
Adrian W. Gelb ◽  
Wayne W. Morriss ◽  
Walter Johnson ◽  
Alan F. Merry ◽  
Anuja Abayadeera ◽  
...  
Keyword(s):  
World Health Organization ◽  
International Standards ◽  
World Health ◽  
World Federation ◽  
Safe Practice ◽  
Health Organization

Heterocycles in the Treatment of Neglected Tropical Diseases

2020 ◽  
Vol 27 ◽  
Author(s):  
Kush K. Maheshwari ◽  
Debasish Bandyopadhyay
Keyword(s):  
Developing Countries ◽  
Heterocyclic Compounds ◽  
Neglected Tropical Diseases ◽  
World Health ◽  
Current Status ◽  
Poor People ◽  
Tropical Diseases ◽  
Concise Review ◽  
The World ◽  
Health Organization

Background: Neglected tropical diseases (NTDs) affect a huge population of the world and majority of the victims belong to the poor community of the developing countries. Until now, the World Health Organization (WHO) has identified 20 tropical diseases as NTDs that must be addressed with high priority. However, many heterocyclic scaffolds have demonstrated potent therapeutic activity against several NTDs. Objective: There are three major objectives: (1) To discuss the causes, symptoms, and current status of all the 20 NTDs; (2) To explore the available heterocyclic drugs, and their mechanism of actions (if known) that are being used to treat NTDs; (3) To develop general awareness on NTDs among the medicinal/health research community and beyond. Methods: The 20 NTDs have been discussed according to their alphabetic orders along with the possible heterocyclic remedies. Current status of treatment with an emphasis on the heterocyclic drugs (commercially available and investigational) has been outlined. In addition, brief discussion of the impacts of NTDs on socio-economic condition is included. Results: NTDs are often difficult to diagnose and the problem is worsened by the unhealthy hygiene, improper awareness, and inadequate healthcare in the developing countries where these diseases primarily affect poor people. The statistics include duration of suffering, numbers affected, and access to healthcare and medication. The mechanism of actions of various heterocyclic drugs, if reported, have been briefly summarized. Conclusion: Scientists and pharmaceutical corporations should allocate more resources to reveal the in-depth mechanism of actions of many heterocyclic drugs that are currently being used for the treatment of NTDs. Analysis of current heterocyclic compounds and development of new medications can help in the fight to reduce/remove the devastating effects of NTDs. An opinion-based concise review has been presented. Based on available literature, this is the first effect to present all the 20 NTDs and related heterocyclic compounds under the same umbrella.

Haemophilia in the 1990s: Report of a Joint Meeting of the World Health Organization and World Federation of Hemophilia

Vox Sanguinis ◽  
1991 ◽  
Vol 61 (3) ◽  
pp. 221-224
Author(s):  
C.K. Kasper ◽  
P.M. Mannucci ◽  
V. Bulyzhenkov ◽  
D.B. Brettler ◽  
A. Chuansumrit ◽  
...  
Keyword(s):  
World Health Organization ◽  
World Health ◽  
Joint Meeting ◽  
World Federation ◽  
The World ◽  
Health Organization

scholarly journals Ethical use of off-label disease-modifying therapies for multiple sclerosis

2021 ◽  
pp. 135245852110302
Author(s):  
Joanna Laurson-Doube ◽  
Nick Rijke ◽  
Anne Helme ◽  
Peer Baneke ◽  
Brenda Banwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
World Federation ◽  
Off Label ◽  
Disease Modifying Therapies ◽  
The World ◽  
Disease Modifying ◽  
Health Organization

Background: Off-label disease-modifying therapies (DMTs) for multiple sclerosis (MS) are used in at least 89 countries. There is a need for structured and transparent evidence-based guidelines to support clinical decision-making, pharmaceutical policies and reimbursement decisions for off-label DMTs. Objectives/Results: The authors put forward general principles for the ethical use of off-label DMTs for treating MS and a process to assess existing evidence and develop recommendations for their use. Conclusion: The principles and process are endorsed by the World Federation of Neurology (WFN), American Academy of Neurology (AAN), European Academy of Neurology (EAN), Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), Middle-East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) and Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (PACTRIMS), and we have regularly consulted with the Brain Health Unit, Mental Health and Substance Use Department at the World Health Organization (WHO).

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