Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2024
ReviewPediatric anesthesia in Australia and New Zealand and health inequity among First Nations and Māori children.
Australia and New Zealand are two countries in the Southern Pacific region. They share many pediatric anesthesia similarities in terms of medical organizational systems, education, training, and research, however there are important differences between the two nations in relation to geography, the First Nations populations and the history of colonization. While the standards for pediatric anesthesia and the specialty training requirements are set by the Australian and New Zealand College of Anesthetists and the Society for Pediatric Anesthesia in New Zealand and Australia, colonization has created distinct challenges that each nation now faces in order to improve the anesthetic care of its pediatric population. ⋯ Two influences have shaped training within New Zealand over the past 40 years; establishment of a national children's hospital in 1990 and, more importantly, acknowledgement that the First Nations people of New Zealand (Māori) have suffered because of failure to recognize their rights consequent to establishing a partnership treaty between Māori and the British Crown in 1840. Health inequities among Māori in New Zealand and First Nations People in Australia have implications for the health system, culturally appropriate approaches to treatment, and the importance of having an appreciation of First Nations people's history and culture, language, family structure, and cultural safety. Trainees in both countries need to be adequately supported in these areas in order for the sub-specialty of pediatric anesthesia to develop further and improve the anesthetic and surgical outcomes of our children.
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In Mongolia, pediatric anesthesia has advanced during the past 25 years through expanded, standardized education programs and international collaboration. Pediatric anesthesia is a recognized specialty, covering all surgical services, including cardiac and transplant, using physicians and nurses. ⋯ As a Low- and Middle-Income Country (LMIC) with low population density and extreme weather, the challenges include insufficient equipment, supplies, and clinician numbers, matching few clinicians to many varied patient locations, and covering surgical emergencies over distance and weather. In Thailand, education and training in pediatric anesthesia remain a focus: Pediatric anesthesia is an official subspecialty, the fellowship is accredited, using a competency-based curriculum with milestones of Direct Observation of Procedural Skills and Entrusted Professional Activities. The Bangkok Anesthesia Regional Training Center (BARTC)-Pediatrics, jointly sponsored by the World Federation of Societies of Anesthesiologists (WFSA) and the Society for Pediatric Anesthesia (SPA), have expanded training to anesthesiologists worldwide. Challenges include difficulty balancing service workload and education, as well as attracting pediatric anesthesia fellows due to the strong private sector job market.
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Paediatric anaesthesia · Sep 2024
ReviewThe role of collaboration in educating the global pediatric anesthesia workforce.
An estimated 1.7 billion children and adolescents do not have access to safe and affordable surgical care, and the vast majority of these are located in low-middle-income countries (LMICs). Pediatric anesthesia, a specialized field that requires a diverse set of knowledge and skills, has seen various advancements over the years and has become well-established in upper-middle and high-income countries. However, in LMICs, due to a multitude of factors including severe workforce shortages, this has not been the case. ⋯ Collaboration models can be operationalized through bidirectional knowledge sharing, training, resource allocation, research and innovation, quality improvement, networking, and advocacy. This article aims to highlight a few of these collaborative efforts. Specifically, the role that the World Federation of Societies of Anaesthesiologists, the Safer Anesthesia from Education program, the Asian Society of Pediatric Anaesthesiologists, Pediatric Anesthesia Training in Africa, the Paediatric Anaesthesia Network New Zealand, the Safe Pediatric Anesthesia Network and two WhatsApp™ groups (global ped anesthesia and the Pediatric Difficult Intubation Collaborative) have played in improving anesthesiology care for children.
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This educational review outlines the current landscape of pediatric anesthesia training, care delivery, and challenges across Canada, Barbados, and the United States. ⋯ Approximately 5% of Canadian children undergo general anesthesia annually, administered by fellowship-trained pediatric anesthesiologists in children's hospitals, general anesthesiologists in community hospitals, or family practice anesthesiologists in underserved regions. In Canada, the focus is on national-level evaluation and accreditation of pediatric anesthesia fellowship training, addressing challenges arising from workforce shortages, particularly in remote areas. Barbados, a Caribbean nation, lacks dedicated pediatric hospitals but has provided pediatric anesthesia since 1972 through anesthetists with additional training. Challenges in its development, common to low-middle-income countries, include inadequate infrastructure and workforce shortages. Increased awareness of pediatric anesthesia as a sub-specialty could enhance perioperative care for Barbadian children. Pediatric anesthesia encompasses various specialties in the United States, with pediatric anesthesiologists playing a foundational role. Challenges faced include recruitment and retention difficulties, supply-chain shortages, and the proliferation of anesthesia sites, all impacting the delivery of modern, high-quality, and cost-effective patient care. Collaborative efforts at national and organizational levels strive to improve the quality and safety of pediatric anesthesia care in the United States.
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Paediatric anaesthesia · Sep 2024
ReviewThe delivery and challenges of Pediatric Anesthesia within the humanitarian sector: Médecins Sans Frontières and Mercy Ships.
Access to healthcare is inequitable. Poverty, natural disasters and war disproportionally effect those most vulnerable, including children. ⋯ Here we describe the delivery and challenges of Pediatric Anesthesia with two such non-governmental organizations; Médecins Sans Frontières (MSF) and Mercy Ships. Descriptions of both are followed by case studies.