Avoidable Anaesthetic Deaths in Low Income Settings: A Narrative Review
Keywords:
Avoidable, Anaesthetic, Deaths, Low income settingsAbstract
Background: One of the most devastating events in the perioperative period is the loss of an apparently healthy patient from a purely avoidable cause. Anaesthesia is a known risk factor for critical incidents that could result in mortality. The complex mix of both human and other associated factors which have seen improvements in developed climes but remain a cause for concern in resource-limited environments is the basis for this review. The authors feel concerned about the sustained loss of precious lives to avoidable causes.
Objective: This paper reviews the available literature for the history, causative factors and summarizes the evidence to prevent such an anaesthetic disaster.
Methods: A systematic literature search was conducted on the incidences of avoidable anaesthetic deaths in the developing countries. The review used the electronic database; Cochrane library, Medline, PubMed, EMBASE and African journal online (AJOL), screening of the titles and abstracts of papers to define relevant studies for inclusion. Searches were limited mainly to studies relating to the developing countries. The search period was up to 2021.
Results: We reviewed studies which were carried out in developing countries and in some developed countries and discovered that most intraoperative deaths from anaesthesia were avoidable and affected patients in the younger age group. Conversely however, one study showed only one anaesthesia-related death (0.05%) in a middle-aged man. Furthermore, avoidable anaesthetic mortality rates were found to be 1:504 in Malawi and 1:133 in Togo.
Conclusion: Anaesthetic deaths in the peri-operative period are largely preventable and have far-reaching consequences on the patient’s relatives, anaesthetists, surgeons, and other hospital personnel involved in the management of the patient. Although the incidence is on a downward trend in developed countries, it is still a major problem in developing countries and human factors account for majority of the cases. The correct use of checklists, paying attention to even the smallest detail, training and re-training of personnel and provision of appropriate equipment in developing countries will go a long way to curb this menace.
References
Walker IA, Iain HW. Anaesthesia in developing countries-a risk for patients. Lancet 2008(3); 371:968-969.
Aitkenhead AR. Anaesthetic disasters: Handling the aftermath. Anaesthesia 1997; 52:477-82
Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet 2012;
Tudjegbe SO, Amadasun FE. What is Anaesthetic desth. Annals of Biomedical Sciences 2010; vol.9): 66579
Vassalo SA. The first death associated with anaesthesia. Anaesthesiology 1997; 87: 928
Cooper JB, New bower RS, Long CD, McPeek B. Preventable anaesthesia mishaps: A study of human factors. Anaesthesiology 1978;49(6): 399-406. Doi: 10.1097/00000542-197812000-00004.
Argo A, Zerbo S, Lanzarone A, et al. Perioperative and anaesthetic deaths: toxicology and medico legal aspects. Egypt J. Forensic SC 2019(9);
Heywood AJ, Wilson IH. Perioperative mortality in Zambia Ann R Coll Surg Engl.1989; 71:354-358
Hansen D, Gausi SC, Merikebu M. Anaesthesia in Malawi: Complications and deaths. Trop doct. 2000; 30:146-149
Glenshaw M, Madzimbamuto FD. Anaesthesia associated mortality in a district hospital in Zimbabwe: 1994 to 2001 Cent Afr J Med 2005; 51:39-44
Maman AF, Tomta K, Ahouangbevi S, Chobli M. Deaths associated with anaesthesia in Togo, West Africa. Trop Doct. 2005; 35:220-222
Enohumah KO, Imarengiaye CO. Factors associated with anaesthesia-related maternal mortality in a tertiary hospital hospital in Nigeria. Acta Anaesthesiol Scand 2006;50;206-210
Cooper JB et al. Preventable anaesthetic mishaps: A study of human factors. Anaesthesiology 1978 Dec; 49(6);399-406
Jones et al. Catchpole K. Department of health human factors reference group interim report. National Quality Board 2012. Accessed 28/06/2020.
Flin R, Fioratou E, Frerk C, et al. Human factors in the development of the development of complications of airway management: Preliminary evaluation of an interview tool. Anaesthesia 2013; 68: 817-25
National committee on confidential enquiries into maternal deaths saving mothers-report of confidential enquiry in maternal deaths in south Africa 2002-2004. http://www.doh.gov.za/docs/reports/2004/savings.pdf accessed 25/06/2020
Walker IA, Iain HW. Anaesthesia supplement. Anaesthesia in developing countries. http://www.blackwell-synergy.com/toc/ana/62/s1.
Mboyne AK, Mutabazi MG, Asimwe JB et al. Declining maternal mortality ratio in Uganda: priority interventions to achieve the Millennium Development Goal. Int J Gynecol Obstet 2007; 98: 285-290
Buck N, Devlin HB, Lunn JN. The Report of a Confidential Enquiry into Perioperative Deaths. London: Nuffield Provincial Hospitals Trust. 1987
Macintosh RR. Deaths under anaesthetics. Br J Anaesth. 1949; 21:107-36
Walker IA, Tom B, Wilson IH. Improving Anaesthesia safety in low-income regions of the world. Current Anaesthesiology Reports. 2014(4);90-99
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