17 research outputs found
Anesthesia care task sharing a clinical audit for the anesthesia care provided by anesthesia technologists in Wad Medani,Central Sudan
No full textIntroduction: The bachelor's degree in anaesthesia sciences program was implemented in Sudan in 1998 to alleviate the shortage of anaesthesiologists while minimizing the anaesthesia related complications of anaesthesia technicians' practice. In the absence of a defined scope of practice and a lack of financial and legal protection, practitioners are leaving their anaesthesia technology careers in Sudan in search of more secure careers, which has resulted in a noticeable gap in anaesthesia practice in Wad Medani, Gezira State. This study was conducted to determine the proportion of anaesthesia care tasks that were carried out by the anaesthesia technologists at four public referral hospitals in Wad Medani, Sudan. Methods: The study was a three-month cross-sectional observational clinical audit of anaesthetic services at four Gezira State Ministry of Health tertiary referral hospitals and included a number of 1559 patients. Data was gathered to describe the perioperative anaesthetic care tasks provided to surgical patients undergoing emergency or elective procedures through a questionnaire that was designed based on the definition of the American Society of Anaesthesiologists of the anaesthesia care tasks. The study began on November 3rd, 2022, and lasted three months, ending on February 2nd, 2023. Results: The analysed data showed an average of 18 cases per day. Out of the total 1559 surgical anaesthesia cases in Wad Medani, 718 (46%) of cases were carried out by anaesthesia technologists without the presence of supervising anaesthesiologists. A percentage of 65.2 of these cases were spinal anaesthesia while general anaesthesia and sedation comprised 25.6% and 9.2% respectively. In the presence of supervising anaesthesiologist, anaesthesia technologists performed over 80% of the anaesthesia care tasks. Conclusions: Anaesthesia technologists make a substantial contribution to Anaesthesia services in Wad Medani. Our results demonstrated that a considerable proportion of Anaesthesia procedures are carried out without any kind of anaesthesiologists supervision. Guidelines and protocols should be developed and implemented to govern anaesthesia practice given the resource constraints in this setting. Regular training on safe anaesthesia practice should be applied. Further research is needed on to assess the provision of anaesthesia care and the extent of surgical delay in regions of displacement
Preoperative testing and medical therapy intervention to improve perioperative outcomes in noncardiac surgical patients.
No full textIntroduction: Cardiovascular disease is the leading cause of death worldwide and a growing concern in low-and-middle income countries, including those in Africa. Patients with cardiovascular disease often have poorly managed chronic conditions in the African setting, which impacts their outcome when they present for non-cardiac surgery. This cohort has an increased risk of perioperative cardiovascular complications. This series of studies explored evidence-based perioperative cardiovascular management strategies in patients with high-risk cardiac comorbidities presenting for non-cardiac surgery. Methods: This was achieved through five objectives which formed five separate but interconnected research studies. The first objective was to study the approach of natriuretic peptide-directed medical therapy in non-surgical patients to inform development of a preoperative protocol in surgical patients through a systematic review. The second objective was to conduct systematic review on exercise therapy in nonsurgical patients to inform development of a preoperative protocol in surgical patients. The third objective was to define the population who would need optimisation before surgery in the Western Cape, South Africa through a prospective observational study of risk stratification. The fourth objective was to explore the broader applicability of perioperative cardiovascular management of high-risk patients by examining cardiovascular outcomes after surgery on the African continent (a sub-study of a larger African cohort study). The fifth objective was to produce national guidelines on cardiovascular risk stratification in a South African and African surgical population. Main results: The systematic reviews showed potential utility for exercise therapy in the optimisation of cardiac patients for non-cardiac surgery. Medical therapy optimisation guided by natriuretic peptide testing did not demonstrate a consistent reduction in natriuretic peptides, but did support a potential mortality benefit in non-surgical patients. The cohort of cardiac patients presenting for non-cardiac surgery in the Western Cape carries significant cardiac risk and needs perioperative cardiovascular management. This was confirmed by the rate of adverse cardiovascular outcomes reported on the African continent. These data supported the development of context-specific national cardiovascular risk stratification guidelines. Conclusion: The cardiovascular burden and risk for perioperative cardiovascular complications presents a challenge in low- and middle-income countries like South Africa, and more broadly Africa. This is a growing phenomenon which needs the collaborative effort of perioperative physicians and the implementation of evidence-based strategies in perioperative cardiovascular management
Additional file 1 of Natriuretic peptide-directed medical therapy: a systematic review
No full textAdditional file 1: Example of search strategy for the systematic review. Description of the standard care arm. Table S1. Data extracted for meta-analyses SMD – standardised mean difference, NP – natriuretic peptide. Table S2. AMSTAR evaluation of previous systematic reviews. Figure S1. Risk of bias summary. Figure S2. Risk of bias graph. Figure S3. Funnel plot for Standard Mean Difference forest plot. Figure S4. Funnel plot for mortality at 4 and 6 months forest plot
Task-sharing anaesthesia in conflict zones: a cross-sectional study of safety gaps and systemic failures in Wad Medani, Sudan
No full textAbstract Background In Sudan, where physician anaesthesiologists are critically scarce (0.47/100,000 population), non-physician anaesthesia providers (NPAPs) deliver most perioperative care, a situation exacerbated by conflict-driven health system collapse. Despite global evidence supporting task sharing and task shifting, NPAP safety outcomes in fragile settings remain unquantified. This study aimed to quantify NPAP anaesthesia delivery, compare supervised and unsupervised safety outcomes, and identify systemic gaps in conflict-affected Sudan. Methods We conducted a cross-sectional clinical audit of 1,559 surgical cases across four referral hospitals in Wad Medani, Sudan (2022–2023). Data on provider roles, supervision, and adverse events were collected by direct observation and record review using tools adapted from WHO/ASA. Data were analyzed using Stata 17.0; risk ratios (RR) with 95% confidence intervals (CI) were calculated, and statistical significance was set at p < 0.05. Ethics approval was obtained from the University of Gezira. Results NPAPs independently managed 46% of cases (718/1,559) in a task-shifting manner, while performing 82% of intubations and 91% of spinal anaesthetics under task sharing. Adverse events were 2.8× more frequent under unsupervised NPAP care (34% vs. 12% supervised; RR 2.8, 95% CI 1.9–4.1), dominated by cardiovascular (58%) and airway crises (41%). Systemic failures included 94% underreporting of adverse events and 0% NPAP access to continuing education. Conclusion NPAPs sustain surgery in Sudan’s crisis but face lethal safety gaps. Urgent reforms require: (1) legislated scope-of-practice guidelines (e.g., Ethiopia’s model), (2) mobile supervision platforms (e.g., WhatsApp consults), and (3) NPAP integration into national surgical plans. These findings inform WHO strategies for conflict-affected states
MOESM1 of The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
No full textAdditional file 1: Example of search strategy for the systematic review
MOESM3 of The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
No full textAdditional file 3: Figure S1. Risk of bias graph
The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
No full textAbstract
Exercise is recommended in patients with cardiac failure. In the perioperative patient, exercise is also gaining popularity as a form of prehabilitation. In this meta-analysis, we examine if exercise is able to reduce natriuretic peptide levels. Natriuretic peptide (NP) has strong prognostic ability in identifying patients who will develop adverse postoperative cardiovascular outcomes. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcomes were to determine whether exercise therapy was effective in reducing NP levels as compared to control group, the shortest time period required to reduce NP levels after exercise therapy, and whether reducing NP levels decreased morbidity and mortality. Full texts of 16 trials were retrieved for this review. Exercise therapy showed a significant reduction in natriuretic peptide levels between the intervention and control groups (SMD − 0.45, 95% CI − 0.88 to − 0.03) with significant heterogeneity between the included trials. This was also shown in the within a 12-week period
MOESM2 of The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
No full textAdditional file 2: AMSTAR evaluation of previous systematic reviews
Natriuretic peptide-directed medical therapy: a systematic review
No full textAbstract
Natriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane database. The primary outcome was to determine whether NP-directed medical therapy is effective in reducing NP levels within 6 months, compared to standard of care. The secondary outcome was to determine whether reducing NP levels is associated with decreased mortality. Full texts of 18 trials were reviewed. NP-directed medical therapy showed no significant difference compared to standard care in decreasing NP levels (standardized mean difference − 0.04 (− 0.16, 0.07)), but was associated with a 6-month (relative risk (RR) 0.82 (95% confidence interval (CI) 0.68–0.99)) reduction in mortality
MOESM4 of The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review
No full textAdditional file 4: Figure S2. Risk of bias summary
