We’re finding new ways to make surgery and anaesthesia safer – and writing the literature as we go. Here’s some of the research from our friends and colleagues around the world.

Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia

Study showing how Lifebox oximeters and training in Malawi lead to an increase in knowledge – and that knowledge put to life-saving use!

Continuous Monitoring in Global Health, Taking Principles of Anesthesia Care Abroad: The Lifebox Model

Luca Koritsanszky writes about our work in Guatemala, and a model of global change at the local level for the Journal of Anesthesia History –

Pulse Oximeter: Disruptive Technology or Standard of Care?

“Lifebox, an organization that has seized a responsibility to be an advocate for the provision of safe anaesthesia and surgery for all patients.” Elizabeth T. Drum, International Anesthesia Research Society, June 15, 2016, Volume 6, Number 12

Lifebox: A Global Patient Safety Initiative 

The safety of anesthesia was dramatically improved by the introduction of pulse oximetry. However, clinicians in low- and middle-income countries lack access to basic anaesthesia equipment. The Lifebox Foundation was formed to determine how a suitable oximeter could be made available to anesthesia providers in these countries. Angela Enright et al. International Anesthesia Research Society, June 15, 2016, Volume 6, Number 12

The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications

Low-cost pulse oximeters have become increasingly available with limited regulatory agency oversight. The Lifebox pulse oximeter is cited as a model proven to meet US FDA accuracy standards. Michael S. Lipnick et al, Anesthesia & Analgesia, 13th April 2016

Surgical Non-governmental Organizations: Global Surgery’s Unknown Nonprofit Sector

Lifebox is one of around 400 NGOs providing surgery in 139 low/middle income countries. Joshua S. Ng-Kamstra et al, World Journal of Surgery, 23rd March 2016

The World Health Organization safe surgery checklist as a catalyst for system improvement

Lifebox trustee Dr Alexander Hannenberg with an eloquent recognition of the context, challenges and value of celebrating incremental improvements that lead to long-term change. Anaesthesia. 2015, 70, 1335-1344

Implementation of the WHO Surgical Safety Checklist and surgical swab and instrument counts at a regional referral hospital in Uganda – a quality improvement project

In spite of the barriers – particularly understaffing, malfunctioning equipment or total lack of it – the improvmenet is evident. Through evaluation and structured feedback, the team was able to raise compliance rates  from 29.5% to 85% (using the Checklist) and from 25.5% – 83% (counting surgical swabs). Lilaonitkul M. et al, Anaesthesia. 2015 Dec;70(12):1345-55

Incidence of hypoxia and related events detected by pulse oximeters provided by the Lifebox Foundation in the maternity unit at Sylvanus Olympio University Teaching Hospital, Togo

The Lifebox oximeter enables early detection of hypoxia for patients undergoing surgery before irreversible damage occurs. Pulse oximetry is cost-effective intervention and should be more accessible in all operating rooms of this type. Sama H.D. et al, Journal of Anesthesia. 2015 Dec;29(6):971-3

Global Surgery

Dr Shrikant Jaiswal is the first and only anaesthetist in Umarkhed, the central Indian town in the state of Maharashtra closest to the rural village where my father grew up. Atul Gawande. The Lancet 2015. doi:10.1016/S0140-6736(15)60764-4

The Amsterdam Declaration on Essential Surgical Care

Lifebox® and WFSA co-signatories. Matthijs Botman et al World Journal of Surgery (2015) 39:1335-1340

Lancet Commission on Global Surgery

All the data from this landmark undertaking to understand and take action on global surgery.

Essential surgery: key messages from Disease Control Priorities, 3rd edition

Lifebox Chair Atul Gawande contributes to this insightful review into the landmark study. Mock CN et all, Lancet. 2015 May 30;385(9983):2209-19

Disease Control Priorities 3

Spotlight on surgery. Evidence on intervention efficacy and programme effectiveness for the leading causes of global disease burden.

Avoidable maternal and neonatal deaths associated with improving access to caesarean delivery in countries with low caesarean delivery rates: an ecological modelling analysis

Increased caesarean delivery in countries with low CDRs could avert as many as 163,513 maternal deaths and 803,129 neonatal deaths annually. G Molina et al. Lancet, 2015 April 27; 385 Suppl 2:S33. do: 10.1016/S0140-6736(15)60828-5

Peri-operative pulse oximetry in low-income countries: a cost-effectiveness analysis

Pulse oximetry is a cost-effective intervention for low-income settings. Samantha L Burn, Peter J Chilton, Atul A Gawande and Richard J Lilford, Bull World Health Organ 2014;92:858-867

The global met need for emergency obstetric care: a systematic review

Considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. H. Holmer et al. British Journal of Obstetrics and Gynaecology. 2015 Jan;122(2):183-9. doi: 10.1111/1471-0528.13230.

Implementation of the WHO Surgical Safety Checklist in an Ethiopian Referral Hospital

Tom Bashford, Sophie Reshamwalla, Jacqueline McAuley, Nikole H Allen, Zahira McNatt, Yohannes D Gebremedhen.  Patient Safety in Surgery 2014, 8:16. doi:10.1186/1754-9493-8-16

Improving Anesthesia Safety in Low-Income Regions of the World

Isabeau A. Walker, Tom Bashford, J. E. Fitzgerald, Iain H. Wilson. Curr Anesthesiol Rep (2014) 4:90–99

Evaluation of a large-scale donation of Lifebox pulse oximeters to non-physician anaesthetists in Uganda.

Finch, L. C., Kim, R. Y., Ttendo, S., Kiwanuka, J. K., Walker, I. A., Wilson, I. H., Weiser, T. G., Berry, W. R. and Gawande, A. A. (2014), Anaesthesia, 69: 445–451. doi: 10.1111/anae.12632

Accuracy of the Lifebox pulse oximeter during hypoxia in healthy volunteers

G.Dubowitz, K.Breyer, M.Lipnick, J.W. Sall, J.Feiner, K.Ikeda, D.G.MacLeod, P.E.Bickler; Anaesthesia 2013 (doi:10.1111/anae.12382)

Quality improvement in low resource settings: an Ethiopian experience
T.Bashford, British Journal of Hospital Medicine, May 2013, Vol 74, No 5

Canadian Journal of Anesthesia Special Issue: Innovation in Perioperative Patient Safety 

Innovative newborn health technology for resource-limited environments

Tropical Medicine and International Health. January 2013, volume 18 no 1 pp 117-128. L. Thairu, M. Wirth, K.Lunze

Health priorities post-2015: surgery must feature on the priority health agenda for the 15 years after 2015

Health in the Post-2015 Development Agenda. S. December 20, 2012. Reshamwalla, S. Kessler, I. Wilson

Surgically avertable burden of obstetric conditions in low- and middle-income regions: a modelled analysis

Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs. H. Higashi et al. British Journal of Obstetrics and Gynaecology. DOI: 10.1111/1471-0528.13198

Implementation of the World Health Organization Surgical Safety Checklist, Including Introduction of Pulse Oximetry, in a Resource-Limited Setting Kwok AC, Funk LM, Baltaga R, Lipsitz SR, Merry AF, Dziekan G, Ciobanu G, Berry WR, Gawande AA, Ann Surg. 2012 Nov 30

Safe perioperative pediatric care around the world.

Paediatric Anaesthesia. 2012 Oct;22(10)947-51. Ivani G, Walker I, Enright A, Davidson A.

Surgical safety checklists: do they improve outcomes?

I. A. Walker, S. Reshamwalla and I. H. Wilson

Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Dziekan G, Herbosa T, Kibatala PL, Lapitan MC, Merry AF, Reznick RK, Taylor B, Vats A, Gawande AA;Safe Surgery Saves Lives Study Group. Qual Saf Health Care. 2011 Jan;20(1):102-7.

International Standards for a Safe Practice of Anesthesia 2010

Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. Can J Anaesth. 2010 Nov; 57 (11):1027-34. Epub 2010 Sep 21

An iterative process of global quality improvement: the International Standards for a Safe Practice of Anesthesia 2010

Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. Can J Anaesth. 2010 Nov; 57 (11):1021-6. Epub 2010 Sep 21.

Global operating theatre distribution and pulse oximetry supply: an estimation from reported data

Funk LM, Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC, Wilson IH, Dziekan G, Gawande AA. Lancet. 2010 Sep 25;376(9746):1055-61. Epub 2010 Jul 2.

Global oximetry: an international anaesthesia quality improvement project

Walker IA, Merry AF, Wilson IH, McHugh GA, O’Sullivan E, Thoms GM, Nuevo F, Whitaker DK; GO Project teams. Anaesthesia. 2009 Oct; 64 (10):1051-60.

Anaesthesia in developing countries–a risk for patients

Walker IA, Wilson IH. Lancet. 2008 Mar 22; 371 (9617):968-9

Anaesthesia in developing countries

Walker I, Wilson I, Bogod D. Anaesthesia. 2007 Dec; 62 Suppl 1:2-3.

Has anesthesia care become safer and is anesthesia-related mortality decreasing?

Merry AF, Webster CS. F1000 Med Rep. 2009 Sep 14;1. pii: 69.