title: Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities.
abstract: BACKGROUND
  Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures.
  
  
  METHODS
  The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed.
  
  
  RESULTS
  Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively.
  
  
  CONCLUSIONS
  A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.
authors.affiliation: From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (P.A., A.L.); Surgical Unit, Médecins Sans Frontières - Operational Centre Brussels (MSF-OCB), Brussels, Belgium (M.T., R.H., Y.A., G.H.H., J.M., Z.N., C.A., I.B.N., A.C., Y.Y., K.M., M.K., M.L.S., M. Ahmed, M. Abdullahi); Ahmad Shah Baba General Hospital, MSF Afghanistan Mission, Kabul, Afghanistan (R.H.); Trauma Centre, MSF Afghanistan Mission, Kunduz, Afghanistan (Y.A.); Boost General Hospital, MSF Afghanistan Mission, Lashkar-Gah, Afghanistan (G.H.H.); Urumuri Obstetric Fistula Centre, MSF-OCB Burundi Mission, Gitega, Burundi (J.M.); Obstetric and Gynaecological Emergency Centre, MSF-OCB Burundi Mission, Kabezi, Burundi (Z.N.); General Referral Hospital, MSF-OCB RDC Mission, Lubutu, Democratic Republic of Congo (C.A.); General Referral Hospital, MSF-OCB RDC Mission, Masisi, Democratic Republic of Congo (I.B.N.); Nap Kembe Surgical and Trauma Centre, MSF-OCB Haiti Mission, Tabarre, Port-au-Prince, Haiti (A.C.); General District Hospital, MSF-OCB India Mission, New Delhi, India (Y.Y.); General District Hospital, MSF-OCB Niger Mission, Dakoro, Niger (K.M.); District Headquarters Hospital, MSF-OCB Pakistan Mission, Timergara, Pakistan (M.K.); Gondama Referral Centre, MSF-OCB Sierra Leone Mission, Bo, Sierra Leone (M.L.S.); General District Hospital, MSF-OCB Kenya Mission for Somalia, Burao, Somalia (M. Ahmed); Health Centre with Surgical Capacity, MSF-OCB South Sudan Mission, Gogrial, South Sudan (M. Abdullahi); Department of Surgery, Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada (E.G.W.); Surgeons Overseas, New York, New York (E.G.W., A.K.); and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (A.K., A.L.).
authors.forename: Promise
authors.initials: P
authors.lastname: Ariyo
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.forename: Rahmatullah
authors.initials: R
authors.lastname: Helmand
authors.forename: Yama
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authors.lastname: Amir
authors.forename: Ghulam Haidar
authors.initials: GH
authors.lastname: Hassani
authors.forename: Julien
authors.initials: J
authors.lastname: Mftavyanka
authors.forename: Zenon
authors.initials: Z
authors.lastname: Nzeyimana
authors.forename: Clemence
authors.initials: C
authors.lastname: Akemani
authors.forename: Innocent Bagura
authors.initials: IB
authors.lastname: Ntawukiruwabo
authors.forename: Adelin
authors.initials: A
authors.lastname: Charles
authors.forename: Yanang
authors.initials: Y
authors.lastname: Yana
authors.forename: Kalla
authors.initials: K
authors.lastname: Moussa
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kamal
authors.forename: Mohamed Lamin
authors.initials: ML
authors.lastname: Suma
authors.forename: Mowlid
authors.initials: M
authors.lastname: Ahmed
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdullahi
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.forename: Adam
authors.initials: A
authors.lastname: Kushner
authors.forename: Asad
authors.initials: A
authors.lastname: Latif
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000191:economics* / Q000379:methods / Q000639:trends; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D008493:Medical Missions / Q000191:economics* / Q000639:trends; D008875:Middle Aged; D005791:Patient Care / Q000191:economics* / Q000379:methods / Q000639:trends; D010820:Physicians / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult