title: Anesthesia Practice and Perioperative Outcomes at Two Tertiary Care Hospitals in Freetown, Sierra Leone.
abstract: Anesthesia in West Africa is associated with high mortality rates. Critical shortages of adequately trained personnel, unreliable electrical supply, and lack of basic monitoring equipment are a few of the unique challenges to surgical care in this region. This study aims to describe the anesthesia practice at 2 tertiary care hospitals in Sierra Leone.
  
  
  
  We conducted an observational study of anesthesia care at Connaught Hospital and Princess Christian Maternity Hospital in Freetown, Sierra Leone. Twenty-five percent of the anesthesia workforce in Sierra Leone, resident at both hospitals, was observed from June 2012 to February 2013. Perioperative assessments, anesthetic techniques, and intraoperative clinical and environmental irregularities were noted and analyzed. The postoperative status of observed cases was ascertained for morbidity and mortality.
  
  
  
  Between the 2 hospitals, 754 anesthesia cases and 373 general anesthetics were observed. Ketamine was the predominant IV anesthetic used. Both hospitals experienced infrastructural and environmental constraints to the delivery of anesthesia care during the observation period. Vital sign monitoring was irregular and dependent on age and availability of monitors. Perioperative mortality during the course of the study was 11.9 deaths/1000 anesthetics.
  
  
  
  We identified gaps in the application of internationally recommended anesthesia practices at both hospitals, likely caused by lack of available resources. Mortality rates were similar to those in other resource-limited countries.
authors.affiliation: From the *Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; †Armstrong Institute of Patient Safety and Quality, Baltimore, Maryland; and ‡Department of Anesthesia, Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: Rahul
authors.initials: R
authors.lastname: Koka
authors.forename: Adaora M
authors.initials: AM
authors.lastname: Chima
authors.forename: John B
authors.initials: JB
authors.lastname: Sampson
authors.forename: Eric V
authors.initials: EV
authors.lastname: Jackson
authors.forename: Onyebuchi O
authors.initials: OO
authors.lastname: Ogbuagu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
authors.forename: Michael
authors.initials: M
authors.lastname: Koroma
authors.forename: Tina P
authors.initials: TP
authors.lastname: Tran
authors.forename: Megan K
authors.initials: MK
authors.lastname: Marx
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D000761:Anesthesia Department, Hospital / Q000639:trends*; D000072080:Anesthesiologists / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017064:Process Assessment, Health Care / Q000639:trends*; D011446:Prospective Studies; D012307:Risk Factors; D012807:Sierra Leone; D062606:Tertiary Care Centers / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult