Anesthesia in Low-Resourced Settings

John G. Brock-Utne MD, PhD, FCMSA is an Emeritus Professor of Anesthesia, now working in the in Department of Anesthesiology, Peri-operative & Pain Medicine at Stanford University Medical Center, Stanford CA 94305, USA.  He has had many years' experience working in low resourced settings.

• 1. Now what will you do?.- 2. What is wrong with this picture?.- 3. No train of four neuromuscular monitor. No problem.-  4. An old anesthetic machine and it’s the only one.-  5. Ether is the only anesthetic and you have never given one.-  6. Transporting a critically ill patient without monitors.-  7. Severe dehydration and no IV solution.-  8. Thinking outside the box .- 9. This is a serious problem.- 10. Always check your facts.-  11. An impossible situation.- 12. No blood bank. Now what? .- 13. What can the problem be?.- 14. Living on the equator.- 15. A word of caution.-  16. A draw-over vaporizer with a non-breathing circuit. Be aware.- 17. A near tragedy.-  18. A tracheostomy is urgently needed and you have never done one.-19. A prolapsed umbilical cord.- 20. The one-eyed patient.- 21. Postoperatively you can’t communicate with the patient.- 22. Traumatic hemothorax and same side central venous access.- 23. A patient with a difficult airway and you have minimal airway equipment.- 24. MRI suite. What can the problem be? .- 25. How should you fill CO2 absorbent in a canister?.- 26. An old anesthetic machine. Look carefully.- 27. A single abdominal knife wound. Easy case.- 28. An endobronchial foreign body.- 29. Lead apron.- 30. A tip for nasal intubation.- 31. A seriously ill patient.- 32. Malignant hyperpyrexia.- 33. An adjuvant to the cuff leak test.- 34. A bronchoscopy surprise.- 35. Doing research in low-resource environments. What to watch out for.- 36. An epidural pump in labor in a low-resource environment. Watch out.- 37. This could be serious.- 38. A case of intraoperative hyperthermia.- 39. A case of myasthenia gravis.-  40. A tragic case.- 41. Essential equipment.- 42. A potentially life threatening problem.- 43. A straightforward case or what?.- 44. A signed consent. Any problem? .- 45. A Cesarean section with twins.- 46. A child bitten by a rabid dog.- 47. What an airway surprise.- 48. A case of a ruptured ectopic.- 49. Glass blood bottles. Any concern? .- 50. An old EKG machine.- 51. A Bird Ventilator.- 52. Intraoperative oozing.- 53. Defibrillator. Watch out.- 54. A case of trismus.-  55. A diagnostic dilemma.- 56. An anesthetic equipment graveyard.- 57. A motor vehicle accident.- 58. My wife is dead, Doctor.- 59. Disposal of soda lime.-  60. Compressed gas containers.- 61. A neck abscess.- 62. An emergency Cesarean section in Togo.- 63. An overdose with witch doctor medicine.- 64. A request from a family member.- 65. A new electronic anesthetic machine.- 66. Hiccups after induction of anesthesia.-  67. What is going on? Was geht ab?.- 68. A trans-Indian ocean flight.- 69. Reinforced (armored) endotracheal tubes. Watch out.- 70. A soda lime dilemma.- 71. Bain circuit Mapleson D. What is the problem?.- 72. Suxamethonium. Never forget.- 73. What a lesson.- 74. How much oxygen is left in an E-cylinder?.- 75. A case of lost in translation.- 76. A sudden intraoperative change in EKG amplitude. Any concern?.-  77. Another reason for preoxygenation.- 78.  What can go wrong with this anesthetic?.- 79. A military conflict.- 80. A dying patient.- 81. A new breathing system.- 82. A small child in a war zone.- 83. A gangrene leg.-  84. Facial trauma.-  85. Always check your facts.-  86. An acute appendix.- 87. Hospital administrator. You have been warned.- 88. A tribal conflict.- 89. Intermittent electrical power failure to an anesthesia machine.- 90. Bonus Question.