2023-09-28 14:46:10 +00:00
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abstract: 'The safety of anesthesia characteristic of high-income countries today
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is not matched in low-resource settings with poor infrastructure,
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shortages of anesthesia providers, essential drugs, equipment, and
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supplies. Health care is delivered through complex systems. Achieving
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sustainable widespread improvement globally will require an
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understanding of how to influence such systems. Health outcomes depend
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not only on a country''s income, but also on how resources are allocated,
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and both vary substantially, between and within countries. Safety is
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particularly important in anesthesia because anesthesia is intrinsically
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hazardous and not intrinsically therapeutic. Nevertheless, other
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elements of the quality of health care, notably access, must also be
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considered. More generally, there are certain prerequisites within
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society for health, captured in the Jakarta declaration. It is necessary
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to have adequate infrastructure (notably for transport and primary
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health care) and hospitals capable of safely carrying out the Bellwether
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Procedures (cesarean delivery, laparotomy, and the treatment of compound
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fractures). Surgery, supported by safe anesthesia, is critical to the
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health of populations, but avoidable harm from health care (including
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very high mortality rates from anesthesia in many parts of the world) is
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a major global problem. Thus, surgical and anesthesia services must not
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only be provided, they must be safe. The global anesthesia workforce
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crisis is a major barrier to achieving this. Many anesthetics today are
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administered by nonphysicians with limited training and little access to
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supervision or support, often working in very challenging circumstances.
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Many organizations, notably the World Health Organization and the World
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Federation of Societies of Anaesthesiologists, are working to improve
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access to and safety of anesthesia and surgery around the world.
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Challenges include collaboration with local stakeholders, coordination
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of effort between agencies, and the need to influence national health
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policy makers to achieve sustainable improvement. It is conceivable that
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safe anesthesia and perioperative care could be provided for essential
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surgical services today by clinicians with moderate levels of training
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using relatively simple (but appropriately designed and maintained)
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equipment and a limited number of inexpensive generic medications.
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However, there is a minimum standard for these resources, below which
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reasonable safety cannot be assured. This minimum (at least) should be
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available to all. Not only more resources, but also more equitable
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distribution of existing resources is required. Thus, the starting point
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for global access to safe anesthesia is acceptance that access to health
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care in general should be a basic human right everywhere.'
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affiliation: 'Merry, AF (Corresponding Author), Univ Auckland, Dept Anaesthesiol,
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Fac Med \& Hlth Sci, Auckland, New Zealand.
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Khan, Fauzia A., Aga Khan Univ, Dept Anaesthesiol, Coll Med, Fac Hlth Sci, Karachi,
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Pakistan.
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Merry, Alan F., Univ Auckland, Dept Anaesthesiol, Fac Med \& Hlth Sci, Auckland,
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New Zealand.
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Merry, Alan F., Auckland City Hosp, Dept Anaesthesia, Auckland, New Zealand.'
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author: Khan, Fauzia A. and Merry, Alan F.
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author-email: a.merry@auckland.ac.nz
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author_list:
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- family: Khan
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given: Fauzia A.
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- family: Merry
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given: Alan F.
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da: '2023-09-28'
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doi: 10.1213/ANE.0000000000002728
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files: []
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issn: 0003-2999
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journal: ANESTHESIA AND ANALGESIA
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keywords-plus: 'MIDDLE-INCOME COUNTRIES; PERIOPERATIVE MORTALITY-RATE; HEALTH-CARE;
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PATIENT SAFETY; GLOBAL INDICATOR; SURGERY; CHECKLIST; OXIMETRY; QUALITY;
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EQUIPMENT'
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language: English
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month: APR
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number: '4'
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number-of-cited-references: '64'
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pages: 1312-1320
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papis_id: 0d10c38f938d325f0428acbb3f0e8517
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ref: Khan2018improvinganesthesia
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times-cited: '24'
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title: Improving Anesthesia Safety in Low-Resource Settings
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000427977400034
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usage-count-last-180-days: '0'
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usage-count-since-2013: '8'
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volume: '126'
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web-of-science-categories: Anesthesiology
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year: '2018'
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