Current opinion in anaesthesiology
-
Healthcare disparities are health differences that adversely affect disadvantaged populations. In the United States, research shows that women of color, in particular Black and Hispanic women and their offspring, experience disproportionately higher mortality, severe maternal morbidity, and neonatal morbidity and mortality. This review highlights recent population health sciences and comparative effectiveness research that discuss racial and ethnic disparities in maternal and perinatal outcomes. ⋯ Obstetrical healthcare disparities are persistent, prevalent, and complex and are associated with systemic racism and social determinants of health. Some of the excess disparity gap can be explained through community-, hospital-, provider-, and patient-level factors. Providers and healthcare organizations should be mindful of these disparities and strive to promote healthcare justice and patient equity. Several solutions provide promise in closing this gap, but much effort remains.
-
Curr Opin Anaesthesiol · Jun 2022
ReviewSafe in the first attempt: teaching neonatal airway management.
Quick and precise facemask ventilation and tracheal intubation are critical clinical skills in neonatal airway management. In addition, this vulnerable population requires a thorough understanding of developmental airway anatomy and respiratory physiology to manage and anticipate potential airway mishaps. Neonates have greater oxygen consumption, increased minute ventilation relative to functional residual capacity, and increased closing volumes compared to older children and adults. After a missed airway attempt, this combination can quickly lead to dire consequences, such as cardiac arrest. Keeping neonates safe throughout the first attempt of airway management is key. ⋯ Every neonatal intubation should be considered a critical event. Below we discuss some of the challenges in neonatal airway management, including anatomical and physiological principles which must be understood to approach the airway. We then follow with a description of current evidence for best practices and training.
-
This review focuses on physician workforce racial & ethnic diversity as a solution to improve perioperative and peripartum health equity. ⋯ Academic medicine has recognized the need to diversify the physician workforce for more than 50 years, and yet Black, Indigenous, and Hispanic physicians remain URiM. Foundational assumptions and power structures in medicine limit entry, advancement, and retention of URiM physicians. Solutions require leadership and institutional commitment to change the policies, procedures, priorities, and culture of academic medicine.
-
Curr Opin Anaesthesiol · Jun 2022
ReviewSafe surgery for every child, implementation of paediatric anaesthesia training in Nigeria.
Nigeria is the most populous country in Africa and 43.5% of its population is under 15 years. Most of these children do not have access to specialized paediatric anaesthesia care when needed, as there are only few paediatric anaesthetists in the country. We highlight the barriers to safe anaesthesia in children, present training opportunities in paediatric anaesthesia and the need for additional, more extensive training in Nigeria. ⋯ To solve the urgent problem of acute shortage of paediatric anaesthetists in Nigeria, general anaesthetists should be empowered through short courses to provide safe anaesthesia for children. A comprehensive Fellowship programme is urgently needed to train specialists in paediatric anaesthesia. Equipment upgrade, creation of children's hospitals and empowerment for research are important end points that require governmental support.
-
Curr Opin Anaesthesiol · Jun 2022
ReviewA pragmatic approach to quality improvement in pediatric anesthesia.
The concept of quality improvement (QI) is well implemented in pediatric anesthesia. Conductance, reporting and publishing of QI projects and -results is well described and promoted. However, the perception of quality might differ between stakeholders and beneficiaries. Based on measures of quality as perceived by healthcare professionals and pediatric patients, a pragmatic approach to choosing the relevant quality measure is suggested. ⋯ In an attempt to embrace both perspectives of quality in pediatric anesthesia care, it is suggested to choose quality items for improvement based on patient safety, professional excellency and benignancy. By following this approach, QI is expected to remain relevant to both healthcare professionals and patients.