Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Anesthesia & Perioperative Care, University of California, San Francisco, California, USA.
Paediatr Anaesth. 2020 Dec;30(12):1308-1321. doi: 10.1111/pan.13960. Epub 2020 Aug 28.
Many low- or middle-income countries (LMICs) continue to suffer from a lack of safe and timely essential and emergency surgery despite growing attention to this problem. Short-term surgical projects (STSPs) continue to play an important role in addressing LMIC unmet surgical need and strengthening local healthcare systems. Guidelines here present recommendations for performing plastic reconstructive STSPs for pediatric patients in a safe, ethical, and effective manner. These guidelines represent consensus physician expert opinions, assembled collaboratively by members of Volunteers in Plastic Surgery and the Society for Pediatric Anesthesia's global health committee, with broad input from physicians practicing daily in LMICs. Organizations must partner with hosts to thoughtfully plan and carefully execute STSPs. We outline crucial items to STSP success, including choice of host facility, team selection, patient selection, staffing, ensuring proper equipment and supplies, disinfecting reusable equipment, creation of a safety culture, and data collection for quality assessment/improvement and research. Patient factors are discussed and recommendations given for developing exclusion criteria, as well as for determining which patients and procedures may require the team to include expertise in pediatric anesthesia or critical care. We recommend that educational opportunities for hosts are sought and advanced to optimize education/training at both the resident and post-trainee levels. Host education during STSPs has become crucial as LMICs ramp up training at a time when their surgical volumes remain grossly behind well-resourced countries. Recommendations here aim to assist organizations, hosts, and volunteers as they navigate the enormously complex and ever changing STSP environment. Patient safety and transfer of knowledge and skills should be central concerns of all who participate in this highly rewarding endeavor.
尽管人们越来越关注这个问题，但许多中低收入国家（LMICs）仍然缺乏安全、及时的基本和紧急手术。短期外科项目（STSPs）继续在解决 LMIC 未满足的外科需求和加强当地医疗保健系统方面发挥重要作用。本指南提出了以安全、合乎伦理且有效的方式为儿科患者实施整形重建 STSP 的建议。这些指南代表了经过深思熟虑的共识，由志愿整形外科学会和儿科麻醉学会全球健康委员会的成员共同协作制定，并广泛征求了在 LMIC 地区日常工作的医生的意见。组织必须与主办方合作，精心规划和谨慎执行 STSP。我们概述了 STSP 成功的关键要素，包括选择主办机构、团队选择、患者选择、人员配备、确保适当的设备和用品、对可重复使用的设备进行消毒、创建安全文化，以及收集数据以进行质量评估/改进和研究。讨论了患者因素，并提出了制定排除标准的建议，以及确定哪些患者和手术可能需要团队包括儿科麻醉或重症监护方面的专业知识。我们建议寻找并推进主办机构的教育机会，以优化住院医师和培训后医生的教育/培训。随着 LMIC 增加培训，而其手术量仍远远落后于资源充足的国家，主办机构的 STSP 期间的教育变得至关重要。本指南旨在协助组织、主办机构和志愿者在这个极其复杂和不断变化的 STSP 环境中进行导航。所有参与这一极具挑战性的工作的人都应将患者安全以及知识和技能的转移作为核心关注点。
