BACKGROUND Critical incidents and mortality related to anesthesia are more frequently observed in low- and middle-income countries in comparison to high-income countries. The difficulties linked to anesthesia in rural areas of the Democratic Republic of the Congo (DRC) and Tanzania have limited documentation. The aim of this study was to comprehensively document anesthesia-related critical events that occurred during surgical missions organized by the nongovernmental organization 2nd Chance in hospitals in DRC and Tanzania. METHODS Data were collected during 6 surgical missions in 3 hospitals in the DRC and 1 in Tanzania. All scheduled surgery patients were included. Anesthesia was administered by a local Non-Physician Anesthesia Provider (NPAP), using local resources, under the supervision of an anesthesiologist from the association. The anesthesiologist reported critical events and collected data. Local teams managed critical events initially, with intervention by the anesthesiologist from 2nd Chance on the local team's request, according to preestablished protocol or if the situation was considered dangerous. Critical incidents associated with anesthesia, including bradycardia, hypoxemia, airway management failure, and equipment problems, were documented from induction of anesthesia until discharge from the recovery room. RESULTS We recruited 201 patients, of whom 192 were evaluated, with 9 patients dropping out due to protocol noncompliance. All patients were American Society of Anesthesiologists (ASA) I (62%; n = 120) or ASA II (38%; n = 72). Among them, 104 individuals (54%) experienced at least 1 critical event, totaling 202 critical events. Hypoxemia emerged as the most common event, affecting 29% of the patients (n = 55) with at least 1 episode. Equipment problems (oxygen supply and/or anesthesia machine failure) occurred in 24% of cases (n = 46), airway management issues in 23% (n = 44), and bradycardia in 6% (n = 12). Hypotension and hypertension were not documented due to the lack of monitoring. The majority of these events (over 60%) required intervention by the anesthesiologist. CONCLUSIONS The occurrence of critical events related to anesthesia appears to be high in this study. Due to numerous limitations, these results cannot be generalized to all hospitals in Tanzania and the DRC. However, this study underscores the challenges faced by anesthesia teams, encompassing inadequate resources, equipment deficiencies, and varying levels of expertise among anesthesia personnel. The research further stresses the significance of addressing these challenges to enhance patient safety.

中文翻译：

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坦桑尼亚和刚果民主共和国短期外科任务期间资源匮乏医院的术中麻醉相关危急事件：一项观察性研究。


背景 与高收入国家相比，与麻醉相关的重大事件和死亡率在低收入和中等收入国家更为常见。在刚果民主共和国 （DRC） 和坦桑尼亚的农村地区，与麻醉相关的困难记录有限。本研究的目的是全面记录非政府组织 2nd Chance 在刚果民主共和国和坦桑尼亚医院组织的外科任务期间发生的与麻醉相关的关键事件。方法 在 DRC 的 6 家医院和 3 家坦桑尼亚的 1 家医院的 1 次外科手术任务中收集数据。所有预定手术患者均被纳入。麻醉由当地的非医师麻醉提供者 （NPAP） 使用当地资源，在该协会的麻醉师的监督下进行。麻醉师报告了危急事件并收集了数据。当地团队最初管理关键事件，根据预先制定的协议或如果情况被认为危险，2nd Chance 的麻醉师应当地团队的要求进行干预。从麻醉诱导到从恢复室出院，记录了与麻醉相关的危急事件，包括心动过缓、低氧血症、气道管理失败和设备问题。结果 我们招募了 201 名患者，其中 192 名接受了评估，其中 9 名患者因不遵守方案而退出。所有患者均为美国麻醉医师协会 （ASA） I （62%;n = 120） 或 ASA II （38%;n = 72）。其中，104 人 （54%） 经历至少 1 次危急事件，共计 202 次危急事件。低氧血症成为最常见的事件，影响了 29% 的患者 （n = 55），至少有 1 次发作。 设备问题（氧气供应和/或麻醉机故障）发生在 24% 的病例 （n = 46） 中，气道管理问题发生在 23% 的病例中 （n = 44），心动过缓发生在 6% 的病例中 （n = 12）。由于缺乏监测，没有记录低血压和高血压。这些事件中的大多数 （超过 60%） 需要麻醉师的干预。结论 在本研究中，与麻醉相关的关键事件的发生率似乎很高。由于许多限制，这些结果无法推广到坦桑尼亚和刚果民主共和国的所有医院。然而，这项研究强调了麻醉团队面临的挑战，包括资源不足、设备不足以及麻醉人员的专业知识水平参差不齐。该研究进一步强调了应对这些挑战以提高患者安全的重要性。