Intraoperative Anesthesia-Related Critical Events in Low-Resource Hospitals During Short-Term Surgical Missions in Tanzania and Democratic Republic of the Congo : An Observational Study

Article Article scientifique Article Intraoperative Anesthesia-Related Critical Events in Low-Resource Hospitals During Short-Term Surgical Missions in Tanzania and Democratic Republic of the Congo : An Observational Study eng 2024-10-28 2025-03-01 author Ponthus Simon 0000-0001-7908-112X From the Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.,2 Chance Association, Geneva, Switzerland. 692560 author Omari Amina Department of Anesthesiology, Tumbi Regional Referral Hospital, Kibaha, Tanzania. author Tesha Selerina Department of Anesthesiology, Tumbi Regional Referral Hospital, Kibaha, Tanzania. author Mbuza Castram Department of Anesthesiology, Provincial General Hospital of Goma, Goma, Democratic Republic of Congo. author Peruzzo Alexis Faculty of Medicine, University of Geneva, Geneva, Switzerland. 855938 author Kabuya Pierre Department of Anesthesiology, Provincial General Hospital of Bukavu, Bukavu, Democratic Republic of Congo. author Yamuremye Richard Department of Anesthesiology, Centre Hospitalier Universitaire Kamenge Bujumbura, Bujumbura, Burundi. author Dumont Lionel From the Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.,2 Chance Association, Geneva, Switzerland. 582454 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) 646-654 10.1213/ANE.0000000000007317 39466917 0003-2999 PMC11805488 https://journals.lww.com/anesthesia-analgesia/fulltext/2025/03000/intraoperative_anesthesia_related_critical_events.24.aspx Background: Critical incidents and mortality related to anesthesia are more frequently observed in low- and middle-income countries in comparison to high-income countries. The difficulties linked to anesthesia in rural areas of the Democratic Republic of the Congo (DRC) and Tanzania have limited documentation. The aim of this study was to comprehensively document anesthesia-related critical events that occurred during surgical missions organized by the nongovernmental organization 2nd Chance in hospitals in DRC and Tanzania. Methods: Data were collected during 6 surgical missions in 3 hospitals in the DRC and 1 in Tanzania. All scheduled surgery patients were included. Anesthesia was administered by a local Non-Physician Anesthesia Provider (NPAP), using local resources, under the supervision of an anesthesiologist from the association. The anesthesiologist reported critical events and collected data. Local teams managed critical events initially, with intervention by the anesthesiologist from 2nd Chance on the local team's request, according to preestablished protocol or if the situation was considered dangerous. Critical incidents associated with anesthesia, including bradycardia, hypoxemia, airway management failure, and equipment problems, were documented from induction of anesthesia until discharge from the recovery room. Results: We recruited 201 patients, of whom 192 were evaluated, with 9 patients dropping out due to protocol noncompliance. All patients were American Society of Anesthesiologists (ASA) I (62%; n = 120) or ASA II (38%; n = 72). Among them, 104 individuals (54%) experienced at least 1 critical event, totaling 202 critical events. Hypoxemia emerged as the most common event, affecting 29% of the patients (n = 55) with at least 1 episode. Equipment problems (oxygen supply and/or anesthesia machine failure) occurred in 24% of cases (n = 46), airway management issues in 23% (n = 44), and bradycardia in 6% (n = 12). Hypotension and hypertension were not documented due to the lack of monitoring. The majority of these events (over 60%) required intervention by the anesthesiologist. Conclusions: The occurrence of critical events related to anesthesia appears to be high in this study. Due to numerous limitations, these results cannot be generalized to all hospitals in Tanzania and the DRC. However, this study underscores the challenges faced by anesthesia teams, encompassing inadequate resources, equipment deficiencies, and varying levels of expertise among anesthesia personnel. The research further stresses the significance of addressing these challenges to enhance patient safety. Adolescent Adult Aged Anesthesia / adverse effects Child Democratic Republic of the Congo Developing Countries Female Health Resources Humans Intraoperative Complications / epidemiology Intraoperative Complications / etiology Male Medical Missions Middle Aged Tanzania Time Factors Young Adult Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false Anesthesia and analgesia 140 3 88a45ad0-d8d3-4633-ab52-e86d6a6133c8 Article (Published version) Public Article_scientifique_from_europePmc.pdf 404772 application/pdf CC BY-4.0 62a2fb7d0b5ac14b575f331a9f63d046ba1517912b90169c7aa268b8c0cea1d6 fe41d88e-a0de-44ae-bdd8-e96ecb081c16 Appendix Public ane-140-646-s001.docx 25913 application/vnd.openxmlformats-officedocument.wordprocessingml.document 824b45ce4a0aff891b661ff9e38e84668edc22fcfb58db297e456a3411f2afad openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Intraoperative Anesthesia-Related Critical Events in Low-Resource Hospitals During Short-Term Surgical Missions in Tanzania and Democratic Republic of the Congo : An Observational Study	Anesthesia and analgesia			2025	76	335

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