Anesthesia in Difficult Locations and in Developing Countries

Abstract Modern anesthesia machines and workstations have evolved steadily over the years in order to improve performance and reduce the risk of accidents. They are now exceedingly complex and sophisticated items of medical equipment. A wide range of monitors and warning devices are now incorporated into these machines and the risk to patients has been greatly reduced. However, these changes have come at a huge cost, as the price of a new anesthesia machine, complete with full monitoring and warning devices, is unaffordable for many anesthesia departments in developing countries. Even when sophisticated machines are donated, the regular servicing and maintenance required need highly skilled engineers who are seldom available in isolated hospitals. As a result, these 'state of the art' machines rapidly deteriorate. They cannot be maintained or repaired locally, and are discarded to the notorious graveyards of equipment found in hospitals throughout the developing world. In recent years, following military activity and natural disasters, there has been increased demand for general anesthesia to be readily available for emergency surgery in isolated regions. In this chapter, we will describe new developments in equipment that is affordable and can function reliably when external sources of oxygen and/or electricity are unavailable. Much of this equipment has been simplified so that it can be maintained and serviced locally without the need for attention from highly trained engineers. Draw-over anesthesia has been revived thanks to a new range of low-resistance vaporizers that do not require high-pressured oxygen supplies. The oxygen concentrator has enabled unlimited supplies of oxygen to be prepared locally rather than being dependent on the delivery of cylinders over long distances, and efficient portable ventilators have been developed. These innovations have contributed to an increase in the safety and availability of anesthesia in difficult, dangerous, and isolated situations.