title: Defining the anesthesia gap for reproductive health procedures in resource-limited settings.
abstract: BACKGROUND
  In resource-limited settings, severe shortages of anesthetists and anesthesiologists lead to surgical delays that increase maternal and neonatal mortality and morbidity.
  
  
  OBJECTIVE
  To more clearly understand the individual components of the anesthesia gap pertaining to reproductive health surgeries and procedures in resource-limited settings.
  
  
  METHODS
  Medline, the Cochrane Library, CINAHL, Embase, and POPLINE were systematically searched for reports published before December 31, 2013. Search terms were related to obstetric surgery, resource-limited settings, and anesthesia.
  
  
  METHODS
  Studies that addressed the use of anesthesia in reproductive procedures in resource-limited settings were included.
  
  
  METHODS
  Reviewers independently evaluated the full text of identified studies, extracted information related to study objectives and conclusions, and identified the anesthesia gap.
  
  
  RESULTS
  Overall, 14 publications met the inclusion criteria. A significant lack of infrastructure, equipment and supplies, and trained personnel were identified as key factors responsible for a lack of anesthesia services.
  
  
  CONCLUSIONS
  A shortage of trained anesthesia providers, equipment, supplies, medications, and infrastructure, along with limitations in transportation in resource-limited settings have produced a wide gap between available anesthesia services and the demand for them for reproductive health surgeries and procedures. Safe, affordable, and scalable solutions to address the anesthesia gap are urgently needed.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: randerson3@partners.org.
authors.forename: R Eleanor
authors.initials: RE
authors.lastname: Anderson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Chavez
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: de Redon
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
mesh_terms: D000349:Africa; D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data*; D000776:Anesthesiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000706:statistics & numerical data*; D060728:Reproductive Health; D000078329:Workforce
keywords: Anesthesia; Low-income countries; Reproductive health