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Anesthesia in Developing Countries: One-Way Traffic?

Section Editor(s): Saidman, LawrenceJochberger, Stefan MD; Lederer, Wolfgang MD, DTM&H, CTCM&H, MSc (CTM); Mayr, Viktoria D. MD; Luckner, Günter MD; Wenzel, Volker MD; Ismailova, Feruza MD; Ulmer, Hanno PhD; Hasibeder, Walter R. MD; Dünser, Martin W. MD

doi: 10.1213/ane.0b013e31818fa436
Letters to the Editor: Letters & Announcements

Department of Anaesthesiology and Critical Care Medicine; Innsbruck Medical University; Innsbruck, Austria (Jochberger, Lederer, Mayr, Luckner, Wenzel)

Department of Anaesthesiology and Critical Care Medicine; University Teaching Hospital; Lusaka, Republic of Zambia (Ismailova)

Institute of Medical Biostatistics; Innsbruck Medical University; Innsbruck, Austria (Ulmer)

Department of Anaesthesiology and Critical Care Medicine; Krankenhaus der Barmherzigen Schwestern; Ried im Innkreis; Austria (Hasibeder)

Department of Intensive Care Medicine; Inselspital; Bern, Switzerland; (Dünser)

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In Response:

We agree with Misra and Koshy that sustainable development of a specialty depends on the overall progress of medicine and is definitely not a one-way traffic.1 There are numerous modes of cooperation between developed and developing countries and there are several committees and agencies involved in collaborative teaching and training of medical staff.2–5 Although, impressive improvements can be achieved, imported development, arranged and conducted by foreign agencies, may also create dependency on supply, thus draining finances and increasing uneven quality.

Due to the enormous interest of Zambian anesthetists in our investigation we were able to evaluate the current standard of anesthesia care throughout the country. This information allows modification of the national health plan and identification of the most needed improvements that can be maintained e.g., by more efficient utilization of supply and personnel. In many developing countries, especially in the rural areas, most patients undergoing surgery are emergency cases. This further influences scope and outcome of disease and has additional impact on anesthesia-associated mortality. Emergency care training for medical staff dealing with emergency surgery and anesthesia is a cost-effective immediate measure. Training of simple airway management, IV access, analgesia as well as induction and maintenance of anesthesia can be taught within months, whereas training of specialists takes years. Improved training offered by specialists to non-specialists working in the same field is a very effective way of improving overall quality of performance within a short time. Furthermore, the standard of basic equipment needs to be determined differently according to the local conditions, depending on the availability of compressed oxygen and electricity and whether maintenance is feasible locally.6 In areas with limited facilities, general anesthesia, if used at all, should be considered primarily in cases where regional or local anesthesia is not reasonable. With encouragement, training, adequate monitoring and a regular supply of appropriate needles and local anesthetic agents regional anesthesia is cheap and effective.7 We regret our lack of precision of our wording regarding the technique of general anesthesia and want to clarify that monitoring and maintenance of general anesthesia did not depend on the presence of a trained anesthesiologist in our survey.8

Stefan Jochberger, MD

Wolfgang Lederer, MD, DTM&H, CTCM&H, MSc (CTM)

Viktoria D. Mayr, MD

Günter Luckner, MD

Volker Wenzel, MD

Department of Anaesthesiology and Critical Care Medicine

Innsbruck Medical University

Innsbruck, Austria

Feruza Ismailova, MD

Department of Anaesthesiology and Critical Care Medicine

University Teaching Hospital

Lusaka, Republic of Zambia

Hanno Ulmer, PhD

Institute of Medical Biostatistics

Innsbruck Medical University

Innsbruck, Austria

Walter R. Hasibeder, MD

Department of Anaesthesiology and Critical Care Medicine

Krankenhaus der Barmherzigen Schwestern

Ried im Innkreis


Martin W. Dünser, MD

for the “Helfen Berührt” Study Team

Department of Intensive Care Medicine


Bern, Switzerland

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1. Misra S, Koshy T. Anesthesia in developing countries: one-way traffic? Anesth Analg 2009;108:674–5
2. Frossard J, Bojarska A. Employment opportunities with international agencies, mission organisations and government hospitals. Anaesthesia 2007;62(Suppl 1):78–83
3. Aitken H, O’Sullivan E. The International relations committee of the Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2007;62(Suppl 1):72–4
4. Enright A, Wilson IH, Moyers JR. The World Federation of Societies of Anaesthesiologists: supporting education in the developing world. Anaesthesia 2007;62(Suppl 1):67–71
5. Cherian MN, Merry AF, Wilson IH. The World Health Organization and anaesthesia. Anaesthesia 2007;62(Suppl 1):65–6
6. McCormick BA, Eltringham RJ. Anaesthesia equipment for resource-poor environments. Anaesthesia 2007;62(Suppl 1):54–60
7. Schnittger T. Regional anaesthesia in developing countries. Anaesthesia 2007;62(Suppl 1):44–7
8. Jochberger S, Ismailova F, Lederer W, Mayr VD, Luckner G, Wenzel V, Ulmer H, Hasibeder WR, Dünser MW; “Helfen Berührt” Study Team. Anesthesia and its allied disciplines in the developing world: a nationwide survey of the Republic of Zambia. Anesth Analg 2008;106:942–8
© 2009 International Anesthesia Research Society