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Background: The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs.
Methods: A comprehensive review of the Mozambique anesthesia system was conducted through interviews with personnel in the Ministry of Health (MOH), a school of medicine, a public central referral hospital, a general first referral hospital, a private care hospital, and leaders in the physician anesthesia community. Personnel databases were acquired from the MOH and Maputo Central Hospital.
Results: Quantitative results reveal minimal anesthesia capacity (290 anesthesia providers for a population of >25 million or 0.01:10,000). The majority of physician anesthesiologists practice in urban settings, and many work in the private sector. There is minimal capacity for growth given only 1 Mozambique anesthesia residency with inadequate resources. The most commonly perceived barriers to safe anesthesia in this critical shortage are lack of teachers, lack of medical student interest in and exposure to anesthesia, need for more schools, low allocation to anesthesia from the list of available specialist prospects by MOH, and low public payments to anesthesiologists. Qualitative results show assets of a good health system design, a supportive environment for learning in the residency, improvement in anesthetic care in past decades, and a desire for more educational opportunities and teachers.
Conclusions: Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.
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http://dx.doi.org/10.1213/ANE.0000000000001223 | DOI Listing |
Ann Ital Chir
March 2025
Department of Orthopedics, Dongtai People's Hospital, 224200 Yancheng, Jiangsu, China.
Aim: To evaluate the postoperative analgesic efficacy and safety of ketorolac tromethamine in tibial plateau fracture (TPF) patients undergoing open reduction and internal fixation (ORIF) surgery.
Methods: This retrospective cohort study included 194 TPF patients treated at Dongtai People's Hospital between October 2022 and March 2024. Patients meeting the inclusion criteria were divided into two groups: the ketorolac tromethamine group (n = 104), who received ketorolac tromethamine combined with imrecoxib, and the control group (n = 90), who received imrecoxib alone after ORIF.
Surg Obes Relat Dis
February 2025
Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address:
Background: Postoperative nausea and vomiting (PONV) commonly occurs following metabolic/bariatric surgery, contributing to increased health care utilization and length of stay (LOS). Studies have suggested the benefit of protein-predominant meals in suppressing gastric tachyarrhythmia and PONV.
Objective: To investigate the impact of a high-protein postoperative liquid diet on PONV and LOS after primary sleeve gastrectomy (SG).
J Cardiovasc Comput Tomogr
March 2025
Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy. Electronic address:
Vet Anaesth Analg
February 2025
Langford Vets, University of Bristol, Langford, UK.
An 8-year-old male neutered British Shorthair cat, weighing 5.12 kg, was referred for chronic mild inappetence, lethargy, bilirubinuria, weight loss and icterus. Diagnostic imaging and serum biochemistry suggested a partial biliary tract obstruction caused by an enlarged pancreas.
View Article and Find Full Text PDFUltrasound Med Biol
March 2025
Midwest Fetal Care Center, Children's Minnesota, Minneapolis, MN, USA; Children's Heart Clinic, Children's Minnesota, Minneapolis, MN, USA.
Objective: No clinical standard exists for intraoperative fetal cardiac monitoring during maternal-fetal surgery for fetal myelomeningocele (fMMC). This pilot study explores the feasibility of using speckle tracking echocardiography (STE)-derived functional measurements to characterize cardiac performance throughout fetoscopic fMMC and compares these measures with other common intraoperative cardiac function parameters.
Methods: Continuous fetal echocardiography was performed during fetoscopic fMMC repair with fetal heart rate assessment every 2 minutes and a 4-chamber cine clip and mitral and tricuspid Doppler inflow patterns captured every 5 minutes.
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