The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety.

Introduction: Current guidelines for the provision of safe anaesthesia from the World Health Organization and the World Federation of Societies of Anaesthesiologists (WFSA) are unachievable in a majority of low and middle-income countries (LMICs) worldwide.

Methods: Current guidelines for anaesthesia and patient safety provisions from the WHO and WFSA are compared with local ability to achieve these recommendations in LMICs.

Conclusions: Influential international organizations have historically published anaesthesia guidelines, but for the most part, without impacting substantial documentable changes or outcomes in low-income environments.

From the Journal archives: Be alert to the risk of unexpected prolonged postoperative hypoxemia!

Purpose: In 1978, Drs. R Knill and A. Gelb published the results of a study to measure the effect of subanesthetic levels of halothane on the ability of fit volunteers to respond to sustained hypoxia, and to determine how long potentially hazardous levels of halothane persist after a brief non-complex surgical procedure in healthy patients.

Ventricular tachycardia after ondansetron administration in a child with undiagnosed long QT syndrome.

Purpose: To describe a case of ventricular tachycardia after co-administration of ondansetron and dimenhydrinate to a child with occult congenital QT prolongation.

Clinical Features: A previously healthy 11-yr-old girl presented for surgical excision of a thyroglossal duct cyst under general anesthesia. Induction and maintenance of anesthesia were unremarkable, and the surgery was carried out without incident.

Composite paraganglioma-ganglioneuroma of the urinary bladder: a rare neoplasm causing hemodynamic crisis at tumour resection.

A 64-year-old man presented with gross painless hematuria. Cystoscopy revealed a submucosal bladder neck mass covered by normal urothelium. During transurethral resection, the patient developed hemodynamic crisis including sinus bradycardia.

Anesthesia and the role of short-term service delivery in developing countries.

Purpose: To clarify the ongoing need for involvement of anesthesiologists in short-term surgical projects in developing countries, and provide information to guide the selection of, application for, and preparation for these rewarding experiences.

Observations: The lack of safe anesthesia services severely limits the performance of needed surgical procedures in developing countries around the world. Even in countries where well-trained anesthesiologists are available in major urban centres, resources are often absent or limited for large numbers of people in rural or remote areas.

Gravity, the belly, and the diaphragm: you can't ignore physics.

Using a radiologic technique, the position and pattern of movement of the diaphragm have been evaluated in three adult volunteers, both awake and anesthetized, during spontaneous ventilation and with muscle paralysis and mechanical ventilation. Studies were made with the subjects in supine and left lateral decubitus positions with tidal and large-volume breaths. Positive end-expiratory pressure (PEEP) was added in studies of two subjects.

High-frequency oscillatory ventilation: lessons from the neonatal/pediatric experience.

Efforts to minimize ventilator-induced lung injury in adults with hypoxemic respiratory failure have recently focused on the potential role of high-frequency oscillatory ventilation (HFOV). However, HFOV has been studied in newborns with hypoxemic respiratory failure for nearly 3 decades. In this brief review, we attempt to summarize key physiological principles learned from this cumulative neonatal/pediatric experience with HFOV.