Assessing pediatric anesthesia practices for volunteer medical services abroad

Background Anesthetic techniques and problems in volunteer medical services abroad are different from those of either the developed countries from whi ch volunteers originate or the host country in which they serve because of differences In patient population, facilities, and goals for elective surge ry. Assessing outcomes is hampered by the transience of medical teams and t he global dispersion of providers. We studied general anesthesia techniques and outcomes in a large International voluntary Surgical program. Methods., Anesthesia providers and nurses participating in care of patients undergoing reconstructive plastic and orthopedic surgery by Operation Smil e over an 18-month period were asked to complete a quality assurance data r ecord for each case. Incomplete data were supplemented by reviewing the ori ginal patient records. Results; General anesthesia was used In 87.1% of the 6,037 cases reviewed. The median age was 5 yr (25th-75th percentiles: 2-9 yr). Orofacial clefts a ccounted for more than 80% of procedures. Halothane mask induction was perf ormed in 85.6% of patients; 96.3% of patients had tracheal intubation, whic h was facilitated with a muscle relaxant in 19.3%. Respiratory complication s occurred during anesthesia in 5.0% of patients and during recovery (posta nesthesia care unit) in 3.3%. Arrhythmias requiring therapy occurred in 1.5 %, including three patients to whom cardiopulmonary resuscitation was admin istered. Prolonged ventilatory support was required in seven patients. Ther e was one death. Inadvertent extubation during surgery occurred in 38 patie nts. Cancellation of surgery after induction of anesthesia occurred in 25 p atients. Overall, complications were more common in younger children. Conclusions: Our study showed that in this setting it is feasible to track anesthesia practice patterns and adverse perioperative events. We identifie d issues for further examination.