{"title":"Challenges in healthcare delivery in low- and middle-income countries","authors":"Hannah Phelan, Victoria Yates, Emma Lillie","doi":"10.1016/j.mpaic.2025.02.010","DOIUrl":"10.1016/j.mpaic.2025.02.010","url":null,"abstract":"<div><div>The Lancet Commission outlines a vision of universal access to safe emergency and essential surgery. Global disparities in perioperative outcomes are recognized, with resource-poor environments and a workforce crisis particularly challenging low- and middle-income countries (LMICs) to provide safe surgical and anaesthesia care. The coronavirus disease (COVID-19) pandemic placed an even greater strain on under-resourced and over-stretched healthcare systems. Bridging the gap to achieve universal access is a substantial undertaking and requires collaboration with high-income countries. Global partnerships are abundant and mutually beneficial, aiming to alleviate the workforce crisis, provide education, training and expertise and raise standards of care in host LMICs. Clinical, leadership and management experience gained in low-resource settings is valued by healthcare systems in high-income countries, acknowledged by curriculum for ‘developing world anaesthesia’. Further challenges to healthcare delivery, training and implementation of change are influence by government policy, cultural traditions, expectations and work ethic. During the COVID-19 pandemic many partnerships were required to move online. The necessity of providing remote support has created its own set of challenges, while also providing novel opportunities for education and collaboration with the global health community. This article describes challenges through reflection on personal experience in Zambia.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 385-388"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obstetric haemorrhage","authors":"Sarah Lambert, Louise England","doi":"10.1016/j.mpaic.2025.02.016","DOIUrl":"10.1016/j.mpaic.2025.02.016","url":null,"abstract":"<div><div>Obstetric haemorrhage is a major cause of maternal morbidity and mortality globally. Identifying risk factors, implementing early risk stratification, and engaging in multidisciplinary team planning can help mitigate its impact. Effective haemorrhage management requires prompt recognition and a rapid, coordinated, multidisciplinary approach. The use of protocols reinforced through targeted drills enhances team vigilance, familiarity, and competency in managing haemorrhage which can lead to improved patient outcomes. This article reviews the management of obstetric haemorrhage including pharmacological interventions, transfusion strategies and surgical techniques.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 327-333"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute pain management and perioperative drugs used in low-resource settings","authors":"Hannah Phelan, Tim Johnson","doi":"10.1016/j.mpaic.2025.02.009","DOIUrl":"10.1016/j.mpaic.2025.02.009","url":null,"abstract":"<div><div>The choice of drugs used during the perioperative period in low-resource settings is dictated by numerous factors. The lack of a reliable supply of essential medications coupled with limited provision of trained staff and necessary equipment are the main causative factors. Drugs used may be unfamiliar to anaesthetists from low-resource settings and those available can vary greatly from day to day. For this reason, it is important to develop an understanding of these drugs and their delivery. The management of acute pain benefits from a structured approach such as that used in the RAT model (Recognize, Assess, Treat) from the Essential Pain Management course. This article provides an understanding of the choice of anaesthetic and analgesic drugs used in a low-resource setting with a focus on those used less commonly in a well-resourced setting.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 375-378"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaesthetic equipment in low- and low-to-middle-income countries","authors":"Claire E. Adams, Michael Dobson","doi":"10.1016/j.mpaic.2025.02.002","DOIUrl":"10.1016/j.mpaic.2025.02.002","url":null,"abstract":"<div><div>There is a discrepancy between healthcare need and the ability to provide safe anaesthesia in low- and low-to-middle-income countries (LMICs). There is a shortage of medically trained anaesthetists. Most anaesthetics are provided by non-physician anaesthetists who may not have studied the core sciences underpinning anaesthesia, but are clinically very competent. Poor infrastructure is common, such as a shortage of piped medical gases and critical care beds. Safe anaesthesia depends on effective technology, and on consumables such as cannulae, and drugs, all of which are under-provided resources in LMICs. Much of the equipment used in the developed world is unsuitable for use in LMICs. Anaesthetic equipment used in LMICs, such as draw-over breathing systems and oxygen concentrators, may be unfamiliar to developed world anaesthetists. Cleaning and maintenance of equipment is usually the responsibility of the anaesthetist, who needs a good understanding of how it works.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 371-374"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antenatal and intrapartum assessment of the fetus","authors":"Zara Cotton, Zoe Thurlwell","doi":"10.1016/j.mpaic.2025.02.012","DOIUrl":"10.1016/j.mpaic.2025.02.012","url":null,"abstract":"<div><div>Stillbirth is a devastating pregnancy outcome for families. Antenatal and intrapartum surveillance has evolved to ensure accurate and regular risk assessments are conducted to allow earlier detection of adverse outcomes without introducing unnecessary interventions. In this article, we outline the latest national guidelines regarding antenatal and intrapartum surveillance in the UK and their implementation into clinical practice. Through discussing latest developments in evidence-based interventions, we explore how clinicians are striving to continue to optimize maternal care practices and work towards the continued reduction in stillbirth rates.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 321-326"},"PeriodicalIF":0.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The perioperative care of Jehovah’s Witnesses","authors":"Emma Murphy, Paul McConnell","doi":"10.1016/j.mpaic.2025.02.008","DOIUrl":"10.1016/j.mpaic.2025.02.008","url":null,"abstract":"<div><div>Jehovah’s Witnesses are a Christian denomination with around 8 million members worldwide. They belief the teachings of the Bible prohibit the transfusion of blood and blood components. Some blood products may be deemed acceptable as part of their beliefs and they may be accepting of intraoperative techniques such as cell salvage. Jehovah’s Witnesses have the right to accept or refuse treatment without providing a reason for doing therefore medical practitioners must respect this even if it would pose threat to the patient’s life. Care of the Jehovah’s Witness should employ a multidisciplinary team approach with senior clinicians. Goals of management include to optimize oxygen delivery and haemoglobin synthesis, reduce blood loss, and correct any coagulopathy.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 353-357"},"PeriodicalIF":0.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Difficult and failed intubation in obstetric anaesthesia","authors":"Priya Datar, Nico Zin","doi":"10.1016/j.mpaic.2025.02.017","DOIUrl":"10.1016/j.mpaic.2025.02.017","url":null,"abstract":"<div><div>Difficult intubation in obstetric anaesthesia remains an important cause of maternal morbidity and mortality. Recent quoted estimates for difficult intubation vary between 1:19 and 1:49 whilst for failed intubation they vary between 1:180 and 1:808. Physiological changes during pregnancy, low general anaesthesia (GA) rates in obstetrics contributing to limited training opportunities, increased obstetric activity performed out-of-hours, a time-pressure environment, isolated location, and obstetric emergencies for which a GA is often utilized are cited contributing to difficult and failed intubation in obstetrics. Human factors often contribute to most situations in difficult and failed intubations. Recent studies seem to highlight that the majority of risk factors contributing to difficult or failed intubation in obstetrics are non-obstetric in nature. Propofol use during GA in obstetric surgery has been associated with a lower risk of difficult intubation. The joint Difficult Airway Society (DAS) and Obstetric Anaesthetists’ Association (OAA) guidelines offer a structured algorithmic approach with decision-making tools to enhance safety. Key strategies include understanding contributing factors, thorough preoperative assessment, planning, good communication and multidisciplinary training and simulation. Adherence to these guidelines is crucial for reducing the maternal and fetal morbidity from difficult or failed intubation during obstetric general anaesthesia.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 295-303"},"PeriodicalIF":0.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.04.010","DOIUrl":"10.1016/j.mpaic.2025.04.010","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 389-390"},"PeriodicalIF":0.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"General anaesthesia for operative obstetrics","authors":"Katherine J Bexon","doi":"10.1016/j.mpaic.2025.02.003","DOIUrl":"10.1016/j.mpaic.2025.02.003","url":null,"abstract":"<div><div>Caesarean birth remains the most performed obstetric surgical procedure globally. In the UK, though most caesarean births are performed under neuraxial anaesthesia, general anaesthesia (GA) remains the quickest option for emergency caesarean birth, and may be more appropriate for complex cases, such as those involving placenta accreta spectrum disorder. Propofol and rocuronium use for GA for caesarean birth in the UK is increasing. Whilst the evidence for routine use of videolaryngoscopy in the obstetric population is currently lacking, there is a growing interest in this, as well as the use of apnoeic oxygenation, total intravenous anaesthesia and processed electroencephalography for obstetric GA. Avoidable GA for caesarean birth may be associated with significant maternal morbidity. Training and clinical practices should continue to emphasize the identification and management of risks including aspiration, accidental awareness, and difficult or failed intubation. Carrying out simulation drills for anaesthetic emergencies, including failed intubation in patients requiring emergency caesarean birth, offers valuable insight into human factors for the multidisciplinary team, and opportunity for structured debriefing and constructive feedback.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 342-347"},"PeriodicalIF":0.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delivering an outpatient pain service","authors":"Lorraine E de Gray, Bharti Seth","doi":"10.1016/j.mpaic.2025.01.004","DOIUrl":"10.1016/j.mpaic.2025.01.004","url":null,"abstract":"<div><div>Chronic pain is a major cause of disability. Outpatient pain management services take a multidisciplinary approach based on a bio-psychosocial framework, providing assessment and management of patients who suffer from chronic pain. The emphasis is on education and promotion of self-management. Appropriate facilities, management and cohesive working is essential to provide evidence-based effective pain management.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 240-244"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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