Department of Anesthesiology, Harvard Medical School, Mass Eye and Ear243 Charles Street, Boston, MA, 02114, USA.
Department of Anesthesiology and Pediatrics, Hospital del Valle North Blvd, 8Th Street NE, San Pedro Sula, Honduras, 21101.
World J Surg. 2023 Dec;47(12):3429-3435. doi: 10.1007/s00268-023-07229-5. Epub 2023 Oct 27.
Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low- and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed.
A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions.
There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, large-scale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.
在过去的 50 年中，全球围手术期死亡率有所下降，但这种下降趋势偏向高收入国家（HICs）。尽管研究对象主要是低风险人群，但目前中低收入国家（LMICs）的儿科围手术期死亡率仍远高于高收入国家（HICs）。这些差异必须加以研究和解决。
对文献进行了叙述性综述，以确定促成因素和潜在的知识差距。讨论了旨在缓解结果差异的干预措施，并为未来的方向提出了建议。
中低收入国家缺乏受过充分培训的儿科麻醉师，必须通过提供此类培训来增加儿科麻醉师的数量。儿科适用尺寸的基本麻醉药物和设备以及基本的基础设施项目通常都无法获得。围手术期工作人员对可能出现的紧急情况准备不足，模拟培训可能有助于缓解这种情况。全球麻醉界已经实施了几种解决方案来解决这些问题。世界麻醉师协会联合会（WFSA）和全球儿童外科学倡议发布了标准，概述了提供安全围手术期儿科护理的基本项目。已经在中低收入国家开发并引入了几个短期教育课程，这些课程要么专门针对儿科患者，要么包含儿科部分。WFSA 还为教育目的维护了一系列单独的教程。最后，在非洲，正在进行大规模的前瞻性数据收集，以检查儿科围手术期结果。不过，仍需要做更多的工作来改善中低收入国家儿科患者的围手术期结果。
