Anesthesia: Hospitals grappling with lack of tools to monitor air supply in surgery

Dr Julianna Nanimambi (standing) engages anesthesia professionals from hospitals across East Africa during capnography training, a partnership initiative of Smile Train and Lifebox to bridge a critical gap in safe anesthesia. [Courtesy, Smile Train] Many hospitals in low-income countries are still battling with a lack of essential tools to monitor if a patient is getting adequate air supply during anesthesia in operating rooms. Doctors have said a capnography which is essential for the task plays a key role in detecting leading causes of anesthesia-related complications and deaths in low-resource settings. This includes detecting the misplacement of the breathing tube supplying oxygen to the patient which doctors say the risks remain greater in children. The tool, however, remains largely unavailable across most low-resource setting operating rooms with research showing there is often a 100 per cent gap between the need for capnography and its availability in low-income countries. Dr Zipporah Gathuya, a pediatric anesthesiologist at The Nairobi Hospital and member of the Smile Train Global Medical Advisory Board said without an oxygen supply, a patient will suffer catastrophic harm in a matter of minutes, including brain damage and death. According to her, increasing the availability of capnography will significantly bridge the gap in anesthesia safety for people including children undergoing surgery in low-resource settings. Dr Gathuya said putting a person under anesthesia without a capnograph is like flying blind because one lacks the basic information required to keep the patient safe. "As healthcare providers, we are concerned that our surgical patients are not monitored with this essential device, even though it's a standard practice in wealthy countries. Capnography shouldn't be a privilege; it's a demand for patient safety everywhere, and it's needed now," said Gathuya. Her sentiments were echoed by Smile Train President and CEO Susannah Schaefer who said in commemoration of World Anesthesia Day, the cleft organization has partnered with safer surgery nonprofit, Lifebox to highlight and address a 30-year access gap that puts the lives of people undergoing surgery in low-resource settings at significant risk. Schaefer said working with industry partner Zug Medical Systems, Smile Train and Lifebox are making available the first high-quality, user-friendly, affordable capnograph with sturdy construction and long battery life. She said the Smile Train-Lifebox Capnograph meets robust specifications for both the monitoring of pediatric patients and use in low-resource settings and underwent rigorous laboratory and field testing. Its introduction in the United States in 1991 led to a dramatic decline in anesthesia-related complications and deaths. Schaefer said concerted efforts are now needed by the World Health Organisation to update global guidelines for safe anesthesia to come into line with high-income practices. She said change in global guidelines and national practices would eventually drive the market demand for more affordable, durable capnographs suitable for use in resource-limited settings. According to her, this year 350 low-resource operating rooms will be equipped with the new Smile Train-Lifebox Capnograph alongside training in its use for anesthesia staff. Benin, Ethiopia, the Philippines, and Uganda are among the countries that will benefit from the initiative. The CEO said the initiative is part of the Smile Train-Lifebox Safe Surgery and Anesthesia Initiative to strengthen the safety of pediatric anesthesia and surgical care in low and middle-income countries. "For more than a decade Smile Train has worked with Lifebox to equip hospitals across the globe with essential monitoring tools for children undergoing surgery," said Schaefer. The launch of the Smile Train-Lifebox Capnograph she said will have a transformative impact on the safety of every child with cleft undergoing surgery and strengthening surgical safety for all surgical patients as a result. Dr Elizabeth Igaga, Director of Programs Safety at Smile Train said capnography has safeguarded surgical patients in the United States for over 30 years and yet, until now, this lifesaving monitoring tool has unfortunately remained inaccessible for most operating rooms in Africa. "The availability of the affordable Smile Train-Lifebox Capnograph is the first significant step to bridge this gap. We hope the WHO takes urgent steps to amend the guidelines for capnography use in safe anesthesia, enabling its rapid adoption by low- and middle-income countries," she said adding, "Let's close this gap and ensure that every surgical patient, regardless of their location, receives the care they deserve." Igaga said the World Health Organization-World Federation of Societies of Anesthesiologists (WHO-WFSA) must upgrade their capnography recommendations in the International Standards for a Safe Practice of Anesthesia from "recommended for patients undergoing general anesthesia and deep sedation" to the highest category, "highly recommended" the equivalent of a mandatory standard. "Furthermore, the WHO's Surgical Safety Checklist must include a capnography in addition to a pulse oximeter as anesthesia monitoring equipment required for safe surgery," she said.

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