Department of Anesthesiology, Eastern Hepatobillary Surgical Hospital, Second Military Medical University, Shanghai, China.
Department of Anesthesiology, Preah Ket Mealea Hospital, Phnom Penh, Cambodia.
BMC Health Serv Res. 2020 Mar 12;20(1):204. doi: 10.1186/s12913-020-5068-z.
The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA.
We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA.
A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients' mean age was 45.0 ± 16.6 years (range, 17-87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3-54.7), orthopedic (27.6%; CI, 25.2-29.9), and urological surgery (14.7%; CI, 12.8-16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7-56.8), 28.2% (CI, 25.9-30.5), and 9.4% (CI, 7.9-10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations.
This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries' inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.
《国际麻醉安全标准》（ISSPA）是由世界麻醉医师学会联合会和世界卫生组织代表制定的。它被推荐为一种评估工具，使发展中国家的麻醉提供者能够评估他们的合规性和需求。本研究旨在描述柬埔寨 8 个月医疗任务期间一家主要公立医院的麻醉服务，并根据《国际麻醉安全标准》评估其麻醉安全问题。
我们对 Preah Ket Mealea 医院的 1953 名患者进行了回顾性研究。根据麻醉服务登记册和问卷调查，对患者的人口统计学特征、麻醉技术和并发症进行了回顾。根据《国际麻醉安全标准》，使用基于检查表的方法记录人员、设施、设备、药物和麻醉药物使用方面的不足。
共有 1792 名患者在手术室接受全身和区域麻醉，161 名患者接受胃镜镇静。患者的平均年龄为 45.0±16.6 岁（范围，17-87 岁）。最常见的三种手术是腹部手术（52.0%；置信区间[CI]，49.3-54.7）、骨科手术（27.6%；CI，25.2-29.9）和泌尿科手术（14.7%；CI，12.8-16.6）。全身麻醉、脊髓麻醉和臂丛神经阻滞分别在 54.3%（CI，51.7-56.8）、28.2%（CI，25.9-30.5）和 9.4%（CI，7.9-10.9）的患者中进行。发生了一例死亡。与专业方面、监测和麻醉管理相关的 26 个项目不符合《国际麻醉安全标准》推荐的标准。缺乏常用药物和监测设备，对麻醉实践的安全构成重大威胁，尤其是在紧急情况下。
本研究增加了柬埔寨等中低收入国家麻醉实践方面的文献。未来的医疗援助应有助于加强这些国家的不足，使其采用国际麻醉安全标准。
