From the Department of Anesthesiology, Critical Care, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2021 Feb 1;132(2):536-544. doi: 10.1213/ANE.0000000000005297.
International standards for safe anesthetic care have been developed by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). Whether these standards are met is unknown in many nations, including Guatemala, a country with universal health coverage. We aimed to establish an overview of anesthesia care capacity in public surgical hospitals in Guatemala to help guide public sector health care development.
In partnership with the Guatemalan Ministry of Public Health and Social Assistance (MSPAS), a national survey of all public hospitals providing surgical care was conducted using the WFSA anesthesia facility assessment tool (AFAT) in 2018. Each facility was assessed for infrastructure, service delivery, workforce, medications, equipment, and monitoring practices. Descriptive statistics were calculated and presented.
Of the 46 public hospitals in Guatemala in 2018, 36 (78%) were found to provide surgical care, including 20 district, 14 regional, and 2 national referral hospitals. We identified 573 full-time physician surgeons, anesthesiologists, and obstetricians (SAO) in the public sector, with an estimated SAO density of 3.3/100,000 population. There were 300 full-time anesthesia providers working at public hospitals. Physician anesthesiologists made up 47% of these providers, with an estimated physician anesthesiologist density of 0.8/100,000 population. Only 10% of district hospitals reported having an anesthesia provider continuously present intraoperatively during general or neuraxial anesthesia cases. No hospitals reported assessing pain in the immediate postoperative period. While the availability of some medications such as benzodiazepines and local anesthetics was robust (100% availability across all hospitals), not all hospitals had essential medications such as ketamine, epinephrine, or atropine. There were deficiencies in the availability of essential equipment and basic intraoperative monitors, such as end-tidal carbon dioxide detectors (17% availability across all hospitals). Postoperative care and access to resuscitative equipment, such as defibrillators, were also lacking.
This first countrywide, MSPAS-led assessment of anesthesia capacity at public facilities in Guatemala revealed a lack of essential materials and personnel to provide safe anesthesia and surgery. Hospitals surveyed often did not have resources regardless of hospital size or level, which may suggest multiple factors preventing availability and use. Local and national policy initiatives are needed to address these deficiencies.
国际安全麻醉护理标准由世界麻醉医师联合会（WFSA）和世界卫生组织（WHO）制定。在包括危地马拉在内的许多国家，这些标准的执行情况尚不清楚，危地马拉是一个拥有全民健康覆盖的国家。我们旨在建立危地马拉公立外科医院麻醉护理能力的概述，以帮助指导公共部门医疗保健的发展。
我们与危地马拉公共卫生部和社会援助部（MSPAS）合作，于 2018 年使用 WFSA 麻醉设备评估工具（AFAT）对所有提供外科护理的公立医院进行了全国性调查。对每个设施的基础设施、服务提供、劳动力、药物、设备和监测做法进行了评估。计算并呈现了描述性统计数据。
在 2018 年危地马拉的 46 家公立医院中，有 36 家（78%）被发现提供外科护理，其中包括 20 家地区医院、14 家区域医院和 2 家国家转诊医院。我们在公立部门发现了 573 名全职外科医生、麻醉师和产科医生（SAO），每 10 万人中有 3.3 名 SAO。有 300 名全职麻醉师在公立医院工作。在这些提供者中，有 47%是麻醉医师，每 10 万人中有 0.8 名麻醉医师。只有 10%的地区医院报告在全身麻醉或神经轴麻醉手术中始终有麻醉师在场。没有医院报告评估术后即刻的疼痛。虽然一些药物（如苯二氮䓬类和局部麻醉剂）的供应情况良好（所有医院的供应率为 100%），但并非所有医院都有基本药物，如氯胺酮、肾上腺素或阿托品。基本设备和基本术中监测器（如呼气末二氧化碳探测器）的供应存在不足（所有医院的供应率为 17%）。术后护理和获得复苏设备（如除颤器）也不足。
这是危地马拉首次由 MSPAS 领导的对公立设施麻醉能力的全国性评估，结果显示缺乏提供安全麻醉和手术所需的基本材料和人员。调查医院无论规模大小或级别如何，往往都缺乏资源，这可能表明有多种因素阻碍了资源的供应和使用。需要采取地方和国家政策举措来解决这些不足。
