Avoidable anaesthetic deaths in low income settings: A narrative review

Abstract

Background: One of the most devastating events in the perioperative period is the loss of an apparently healthy patient from a purely avoidable cause. Anaesthesia is a known risk factor for critical incidents that could result in mortality. The complex mix of both human and other associated factors which  have seen improvements in developed climes but remain a cause for concern in resource-limited environments is the basis for this review. The authors  feel concerned about the sustained loss of precious lives to avoidable causes. This paper reviews the available literature for the history, causative factors  and summarizes the evidence to prevent such an anaesthetic disaster.

Method: A systematic literature search was conducted on the incidences of avoidable anaesthetic deaths in the developing countries. The review used  the electronic database; Cochrane library, Medline, PubMed, EMBASE and African journal online (AJOL), screening of the titles and abstracts of papers to  define relevant studies for inclusion. Searches were limited mainly to studies relating to the developing countries. The search period was up to 2021. 

Results: We reviewed studies which were carried out in developing countries and in some developed countries and discovered that most intraoperative  deaths from anaesthesia were avoidable and affected patients in the younger age group. Conversely however, one study showed only one anaesthesia-  related death (0.05%) in a middle-aged man. Furthermore, avoidable anaesthetic mortality rates were found to be 1:504 in Malawi and 1:133 in Togo.

Conclusion: Anaesthetic deaths in the peri-operative period are largely preventable and have farreaching consequences on the patient’s relatives,  anaesthetists, surgeons, and other hospital personnel involved in the management of the patient. Although the incidence is on a downward trend in  developed countries, it is still a major problem in developing countries and human factors account for majority of the cases. The correct use of checklists,  paying attention to even the smallest detail, training and retraining of personnel and provision of appropriate equipment in developing countries will go  a long way to curb this menace.