2020 FSA Posters

P063: DON'T THROW THAT AWAY: OUR EXPERIENCE WITH LIMITED RESOURCES AND RE-USING MEDICAL EQUIPMENT WHILE PROVIDING ANESTHESIA DURING A MEDICAL MISSION TRIP
Alex N Knight, DO; Alberto Bursian, MD; Kevin Voisin, DO; Yury Zasimovich, MD; University of Florida College of Medicine

Introduction: In 2015 it was estimated that nearly 5 billion people lacked access to safe, affordable and timely surgical and anesthesia care [1]. For many years, medical mission trips have taken place around the world to provide care to these underserved populations. A large majority of these medical missions include surgical procedures. Anesthesia providers should follow established guidelines [2] when preparing for these situations with the goal of providing safe and ethical care. There are many challenges of providing care in foreign countries including language barriers, lack of resources, and the reprocessing of single-use anesthesia equipment [3,4].

Case Report: Our anesthesia team traveled to Ecuador to provide general anesthesia for fixation of congenital limb deformities. The facility had 2 operating rooms (ORs) and an overnight post-anesthesia care unit that was staffed by an in-house primary care physician. We familiarized ourselves with the available airway equipment, supplies and anesthesia machines, which included standard ASA machine checks. We were repeatedly told by the OR manager “don’t throw that away” when you use it. The facility’s standard practice was to sterilize/re-process all anesthesia equipment/supplies except for intravenous (IV) tubing, IV catheters, and syringes. Otherwise, suction catheters, temperature probes, circuit tubing, masks and all airway supplies including endotracheal tubes, laryngeal mask airways, etc. were reprocessed even though many of these devices were produced as single-use devices (Figure 1). We found that some of the reprocessed single-use medical devices had defects that made them un-safe, such as small cracks in an endotracheal tube and unreliable light sources on direct laryngoscopy blades. The facility agreed upon our recommendation to retire/discard these supplies. All medications available to us were new and unopened; however some had already expired. In one case, we had to administer expired dantrolene to a child with signs of malignant hyperthermia (Figure 2). Although this had expired eight years prior, improvement was noted in his symptoms prior to his transfer to a pediatric intensive care unit. Overall we were able to adapt and improvise in order to provide safe anesthesia care with the equipment that we had available to us.

Discussion: Anesthesia providers should review established multi-disciplinary guidelines [2] when preparing for medical mission trips in foreign countries. This should include bringing supplies and emergency medications after discussing their availability with the local hospital [2,5]. One study found that up to half of single-use medical devices do not function after just one reprocessing and that most devices can only be reprocessed five times. Anesthesia providers should weigh the advantages and disadvantages of using reprocessed single-use medical equipment [4]. It is important that anesthesia teams have an opportunity to become familiar with local equipment and have the ability and willingness to adapt and improvise if needed.

References:

[1] Truche et al. Globalization and Health. 2020;16:1

[2] Butler et al. Pediatr Anesth. 2018;28:392–410.

[3] Pieczynski et al. Medical Education. 2013; 47: 1029–1036

[4] Popp et al. International Journal of Hygiene and Environmental Health. 2010;302-307

[5] Larach et al. Anesthesia & Analgesia. 2019;129:5

Figure 1.

Figure 2.