Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2025
Capacity of Anesthesiology Residency Programs in Four East African Countries: Can Supply Meet the Demand?
By 2015, 4 East African countries (Kenya, Uganda, Rwanda, and Burundi) had identified a deficit in the number of anesthesiologists, with a mean density of 0.30 physician anesthesia providers (PAP) per 100,000 population, which was significantly lower than the World Federation of Societies of Anaesthesiologists (WFSA) recommended minimum of 5.0/100,000 population. This workforce shortfall has been recognized as 1 factor that may negatively affect surgical outcomes. This survey sought to assess the capacity of anesthesia residency programs to meet recommended human resource standards in these countries. ⋯ The PAP workforce deficits significantly outstripped the annual output of all residency programs. Anesthesia societies need to raise awareness about this deficit and engage policymakers to increase investment in anesthesia training, including providing scholarships and employment of PAP in training institutions. Integrating nonuniversity-based residency programs may support an increased output. The attainability of the 2030 workforce goals will need review. National strategies are needed to increase the total anesthesia workforce, which includes nonphysician anesthesia providers (NPAPs) as part of the task-sharing framework.
-
Anesthesia and analgesia · Jan 2025
Optimal Maternal Ventilation During Laparotomy with General Anesthesia in Pregnancy in the Ovine Model.
General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia. ⋯ This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded.