Anesthesia and Perioperative Care

Anesthesia’s impact often goes unrecognized, but in low- and middle-income countries (LMICs) the lack of access to safe anesthesia looms as a crisis. Anesthesia-related mortality has unacceptably high levels in these countries, especially for the maternal and pediatric populations. The state of the crisis has been largely underestimated as a result of the lack of outcomes measurement, including perioperative mortality, and the overall absence of patient follow-up. The shortage in the number of anesthesiologists is exacerbated by the fact that the available anesthesia providers spend only 60 percent of their time in clinical care. The shortage of physician anesthesiologists has led to task-shifting to nurses and technicians as the most feasible workforce alternative in many LMICs. Safe administration of anesthesia involves airway management and perioperative care. Both local and regional anesthetic techniques are low cost and low technology; they offer achievable proficiency and have a good safety record when basic sterile techniques are employed and key safety steps are observed.