Anesthesia and Perioperative Care

Excerpt

In the not-so-distant past, the impact of safe anesthesia on surgical outcomes often went unrecognized. Beginning in the 1950s, as surgical techniques advanced, strategies to improve patient safety and surgical outcomes were emphasized; physician anesthesia providers were recognized as essential members of surgical teams in high-income countries (HICs). Most low- and middle-income countries (LMICs), which have the greatest unmet surgical need, have not been able to apply the anesthesia advances in patient care and monitoring that have proven so successful in HICs. The availability of anesthesia providers is limited in LMICs, and many lack requisite training and supervision.

Although many of the advances that improved outcomes in anesthesia and surgery are technology based and expensive, several early interventions are feasible in all settings. As surgical intervention expands in LMICs to fill the growing and largely unmet treatment needs, an anesthesia crisis looms.

This chapter reviews the historical, remote, and recent global data that reveal the contributions of anesthesia to surgical and perioperative outcomes, as well as the anesthesia-associated morbidity and mortality rates, where available. It emphasizes the role of outcomes analysis and quality improvement, and it discusses the global cost and cost-effectiveness data, as well as the limited data from LMICs on human resources, education, and outcomes. Finally, this chapter proposes effective and responsible policy and funding solutions for the anesthesia crisis in most of these countries.