Con: anesthesia for children in the developing world should be delivered by medical anesthetists.

Surgical care for pediatric patients in poor countries is severely limited by the availability of surgeons, healthcare resources and investment in anesthesia services. Where a surgical service exists, a shortage of trained medical anesthetists limits the care that can be delivered. Where no doctors are available to administer anesthesia, some countries have utilized nonmedical anesthesia providers to provide a service. These providers should be integrated with, and supported by, their medical colleagues to ensure safe practice. Action at governmental level is required to resolve the difficult issues described in this paper.