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Abstract

Background: Access to safe surgery and anesthesia care is grossly inadequate in low- andmiddle-income countries, with a shortage of anesthesia providers contributing to this crisis. InNamibia, medical officers typically receive no >3 months of informal training in anesthesia. Thisstudy sought to determine the prevalence, currently unknown, of intraoperative adverse anesthetic events in this setting. Further, we assessed surgical volume, complications, and mortalityoutcomes at the district hospital level.Methods: This was a prospective observational study over 7 months involving 4 district hospitals from geographically separate and diverse areas of Namibia. A standardized protocol wasused to record adverse anesthetic events during surgery, surgical volume, and complicationsincluding mortality.Results: A total of 737 surgical procedures were performed during the study period. There wasa 10% prevalence of adverse anesthetic events intraoperatively. Of these, 70% were related tohypotension and 17% due to hypoxia and/or difficult/failed intubation. Ninety-eight percent ofpatients were classed as low risk (American Society of Anesthesiologists I or II). Seventy-twopercent of the surgical workload was in obstetrics and gynecology, with over half being for urgentobstetrics. Perioperative mortality rate was 1.4/1000, with an overall surgical complication rateof 1.6% and a surgical infection rate of 0.8%.Conclusions: We found a 10% prevalence of adverse anesthetic events intraoperatively whenanesthesia was administered by medical officers with no >3 months of informal training in thislow-resource environment. The patients were considered low risk by the medical officers responsible for the anesthesia, yet these events had the potential to lead to patient harm.

Item Type:	Article
Authors/Creators:	Ottaway, AJ and Kabongo, L
Keywords:	anaesthetic events, Namibia, hospitals, surgical outcomes
Journal or Publication Title:	Anesthesia and Analgesia
Publisher:	Lippincott Williams & Wilkins
ISSN:	0003-2999
DOI / ID Number:	10.1213/ANE.0000000000002695
Copyright Information:	Copyright 2017 International Anesthesia Research Society
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