Challenges in administering anesthesia for emergency surgery in peripheral teaching hospitals

Dr. Baisakhi Laha; Dr. Tapobrata Mitra

Volume : VIII, Issue : VI, June - 2019

Challenges in administering anesthesia for emergency surgery in peripheral teaching hospitals

Dr. Baisakhi Laha, Dr. Tapobrata Mitra

Abstract :

The factors that may hamper adequate anesthesia support to emergency surgery in peripheral teaching hospitals have not been systemically explored in the Indian setting. We conducted a questionnaire-based observational study in two small town teaching hospitals to address the current knowledge gap in the context of non-obstetrical emergency surgery. Results: Data from 65 cases (65.6% males; median age 30 years; 37% referred; 83.1% general surgery cases) were analyzed. Majority hailed from socioeconomically weaker strata and had little formal education. Proper history of the current illness could be obtained from 29.2%. There was lack of awareness regarding major co-morbidities like ischemic heart disease, asthma, epilepsy, diabetes and drug allergy. At presentation, 74% subjects were suboptimal in terms of fluid balance or hemoglobin status. Many cases had to be taken up for surgery without support of chest X-ray, hemogram, serum creatinine, electrolytes and coagulation profile. Availability of anesthesia equipment, emergency drugs and nursing support were satisfactory. However, necessary blood components were not available in all cases. In most instances the attending anesthetist was alone without assistants or peers to call upon in case of need. Senior (consultant) colleagues were available only over phone. ICU support was also not optimum. Conclusions: Anesthesiologists working in peripheral hospitals in India are likely to come across many impediments that our study has documented. Some stem from socioeconomic factors like illiteracy which cannot be resolved in the short-term. However, system related impediments can be removed through administrative will and measures such as increasing staff on emergency duty, emergency investigation support and strengthening of ICU facilities.