15th wca 2012 ppt

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  • 1.Dr RB Rana and Team Nepal

2. Dr Rana RB, Dr Manandhar ML, Mr Shrestha Naba RajNational Academy of Medical Sciences, Kathmandu, Bagmati Zone: Nepal (ASIA) 3. Nepal is a land-locked Asian country which borders India to its east, south and west and China to its north. It covers an area of 147,181 km2 and varies between an altitude of 60 m and 8,848 m (Mt Everest). Current population27.5 million (2010 projected) with an annual growth rate of 1.94 per cent (CBS 2009)1. 4. MMR (2010 survey) as 229/100,000 livebirths. (by training to community worker &doctors) MDG5 target for 2015 is to reduce 213. Among these deaths, some 41% occur in ahealth facility (FHD 2009). Workup: Producing doctors capable of providing obstetriccare including c-section and Producing anesthesia assistant to provideanesthesia under supervision in health facility ofremote areas. 5. Anesthesia assistants (AA) are paramedical staffs working under the government with three years medical science background and at least 6 months anesthesia assistant training. Now AA training is of one year duration with the same background since 2011. These attempts will help expand and strengthen Comprehensive Emergency Obstetric Care sites in different areas of need. Nepal is also attempting to improve access to surgical services to the remote areas by availing an anesthesia machine which is affordable, simple to use, and requiring easy maintenance. We evaluated the appropriateness and user friendliness of the Universal Anesthesia Machine (UAM) in our context. 6. UAM2 is a simple anesthetic British Standards3 work station that looks familiar with clear layout. The key differences from a standard Boyles machine are the oxygen concentrator, drawover vaporizer, breathing bellows and balloon valve. The system provides continuous anesthesia flow, reverting to drawover mode if air is entrained or if electricity fails (O2 concentration stops), with the vaporizer and bellows continuing to function as normal. In both modes, oxygen can alternately be supplied via cylinder, central line or the side emergency inlet. Almost all parts are designed to require minimum or no services for maintenance4. 7. To assess the functions of the UAM in termsof reliable oxygen supply, anesthetic agentflow, breathing system and scavengingsystem and To assess the user friendliness, 8. Four UAM machines provided by the NICK SIMONSFoundation, New York were distributed to fourdifferent hospitals (two central and two peripheralhospitals) of Nepal. Three to five days orientation to at least one qualifiedanesthesiologist and anesthesia assistants of each ofindividual sites were oriented with didactic and livedemonstration. All the users were also oriented with an evaluationsystem by recording in the pre-set form. Thereadymade forms contained the patientsdemographic information, surgical details, oxygenmonitor findings, airway management, breathingcircuit types and maintenance and recovery details asshown in the table below. 9. A team of anesthetist, biomedical technician andadministrator carried out follow-up visited to each siteevery two months. Continuous communication was maintained betweenfollow-up visits through email and phone calls to helpfor any problem and their management. Adequate forms to record various parameters of patientand the machine were also made available. At the end of the study period, three useranesthesiologists and 8 user AAs were asked to rate theuser perspective of layout and setting up of machineand also the UAM response to patients variables asshown in figure 6. Collected records were finallyanalyzed. 10. Age (yrs) / Sex Distribution 294300250200 128150100 36 38 30 50 610 1121 20 21 1920060 Male Female 11. Total case 641 in 6 months and one week. Figure 1 shows: smallest patient was of 22 days and oldest is 85 years old. Elective 69% and 31% found as emergency. Figure 2 shows Gen Surg 35% Obstetric 17% were obstetric Figure 3: The original bellow was used in majority of the cases Ayres T-piece and Bains circuit Maintenance aurnd recovery of patients are shown in figure 4& 5. Oxygen saturation in elective and emergency patients areshown in figure 6. The user evaluation of the machine and thepatient parameter are shown in figure 7 and 8. 12. It may be too early to conclude the evaluation of UAM and itsusefulness. However, the result clearly favors the acceptabilityof the UAM due to its simplicity, safety, reliability andfunctionality. It can be easily oriented within a week and canbe used confidently. Most of the user commented about thehandheld bellow which sticks the user with the machine andpatient (favoring ASA standard I monitoring).This initialimpression to the UAM is very positive in Nepals context. It isreliable in terms of oxygen supply system, vaporizer and useof a variety of breathing circuits. Its simplicity, versatility andnegligible maintenance cost having continuous flow andcombined drawover system in different geographic locations(remote area) are attractive features to any resource limitedareas to serve quality anesthesia in comfortable way. 13. 1. Nepal Millennium development goals report, Progress report 2011.2. Fenton PM. Maternal deaths and anaesthesia technology in the 21st century. Anaesthesia News 2010; 273: 5-83. AAGBI (2009) Section 4: Standards. In: Safe Management of Anaesthetic Related Equipment. AAGBI, London: 8-94. OES Medical (2010) Universal Anaesthetic Machine User Manual CE 0120 Doc 1973- 510