Anesthesiology in developing nations

[SBS]

Hi,

I was recently intrigued by an article I read about the lack of medical technology in third world and developing countries. The article mentioned that many common medical instruments (ECG, pulse oximeter) are not present in hospitals and clinics in many parts of the world. It was also linked to an article about the $100 laptop that is targeted for these regions.

As an electrical engineer with experience in measurement devices, I've been thinking about how I can attack this problem. I'd like to develop a low-cost, multifunction portable medical measurement instrument for un-developed countries.

One use case I can think of is monitoring the patient when they are under anesthesia. I understand that hospitals in many parts of the worlds do not have the same equipment that we have here.

I would like to get your perspective on this...

Specifically, I'd like to know:

1) Do you have any experience with surgery in third-world or developing nations? What do they typically have (or don't have)?

2) What equipment do you feel is necessary to have when monitoring a patient under anesthesia? What equipment is very helpful but not absolutely important?


Thanks,
Sal

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[Mman]

I have no experience doing anything in 3rd world countries except getting drunk on spring break.

I'd imagine that a pulse ox would be #1 on my wish list for monitoring during an anesthetic. #2 might be a tie between a BP cuff and some kind of end tidal CO2 monitor. After those you could give me an EKG as dessert.

 

[Planktonmd]

Hi,

I was recently intrigued by an article I read about the lack of medical technology in third world and developing countries. The article mentioned that many common medical instruments (ECG, pulse oximeter) are not present in hospitals and clinics in many parts of the world. It was also linked to an article about the $100 laptop that is targeted for these regions.

As an electrical engineer with experience in measurement devices, I've been thinking about how I can attack this problem. I'd like to develop a low-cost, multifunction portable medical measurement instrument for un-developed countries.

One use case I can think of is monitoring the patient when they are under anesthesia. I understand that hospitals in many parts of the worlds do not have the same equipment that we have here.

I would like to get your perspective on this...

Specifically, I'd like to know:

1) Do you have any experience with surgery in third-world or developing nations? What do they typically have (or don't have)?

2) What equipment do you feel is necessary to have when monitoring a patient under anesthesia? What equipment is very helpful but not absolutely important?


Thanks,
Sal

You know what would be great:
A module that you can connect to that 100 dollars laptop and allow you to monitor hemoglobin Oxygen saturation, EKG and BP.
If you could add end tidal CO2 measurement that would be great but not the most important thing because they don't worry about malpractice lawyers in these countries.
Like that you could save on the cost of an independent LCD and you could even store the numbers and produce electronic records.

 

[jwk]

2) What equipment do you feel is necessary to have when monitoring a patient under anesthesia? What equipment is very helpful but not absolutely important?


Thanks,
Sal

#1 - Pre-cordial stethoscope

#2 - manual BP cuff

#3 - vigilant observant anesthesia provider

The rest is gravy in a 3rd world country.

The three items above plus an EKG monitor was what everyone had just 20-25 years ago. I've done thousands of anesthetics this way. Many become so dependent on the monitors that they forget the most important monitor is YOU paying attention to THE PATIENT.

One of my favorite ways to mess with anesthesia students is to turn off the monitors, then ask them "what now?" Look at the patient's color to help determine if they're oxygenating. Put a finger on a pulse and keep it there - rate and rhythm are right there. Watch their chest rise and fall and see if there is water vapor in the mask or tube.

Is it ideal? Nope. Does it work? Yep. Do I want to go back to doing it without monitors? Of course not, but if one of my monitors doesn't work right in the middle of a case, I don't hit the panic button either.

 

[Monty Python]

Hi,


1) Do you have any experience with surgery in third-world or developing nations? What do they typically have (or don't have)?

2) What equipment do you feel is necessary to have when monitoring a patient under anesthesia? What equipment is very helpful but not absolutely important?


Thanks,
Sal

While this is slightly tangential, my emergency field anesthesia equipment for the military is a pulse ox and my finger on the carotid - gives a measure of both HR and systolic. That and my Mark 1 eyeballs watching the items JWK mentioned above. I guess ETCO2 in a tiny thingofmobob would be nice but not absolutely essential.

 

[iron]

Having done several medical missions organized from the States and a few trips just working with locals, I can comment on the wide variety of anesthetic equipment. Unfortunately a lot of it is broken and no one can afford parts or there isn't a qualified technician to repair. EKG is common. Pulse ox a little less. BP is often manual. Gas analysis - nil. Unfortunately I've seen equipment available but not being used.

An Australian study on critical incidents analyzed events and which monitors picked up events early or contributed to a quick and succesful outcome. Pulse oximetry is the tops, particularly with pleth. I would probably choose end-tidal analysis next - disconnect, endotracheal intubation verification, all show here faster than desaturation. EKG doesn't pick up events early as many events will be respiratory and your pulse ox/pleth can give you rhythm and perfusion. But since it is a standard monitor, it's hard to imagine practicing without it.

The other monitors should be resistant to breakage, not need maintenance and re-usable: esophageal/precordial stethoscope as a previous poster mentioned. Manual BP cuff. Finger on the pulse.

 

[docdoc]

I practiced as a vet for 4 years before returning to med school, part time while in med school. I'm not sure if the experience counts but I have run anesthesia on thousands of animals (while doing the surgery) with an esophageal stethoscope, pulse ox, checking femoral pulse, mm color, depth of respirations. After taking a few anesthesia rotations I got pretty nervous anesthetizing animals when I knew what I wasn't monitoring. Ignorance was bliss.

 

[srik]

hi yes as amember of 3rd world all this is true but atlesat in pakistan we are more advances and we got all the things which r necssory 4 monitoring in operationtherater. rest if u had a time i had a question would u ans plz as consultant .i had given anesthesia to 29yr old male 4 fistelectomy & give him inj nalbuphine then suddenly he went into cardiac arrest i manage him with ippv and oxygen and drugs and he fine . he had a past history of operation 4 tounge tieat the age of 5 yearsand alsohad cardiac arrest history at that time too . so my question is what i do when i again give him anesthesia would u give some expert comments plz if u had some time , i am thankful to u inadvance .