Bridging the Gap: Pulse Oximetry and Safer Anesthesia

“When you hear stories about patients saved when you have a pulse oximeter, and then stories of patients that were lost because they didn’t have a pulse oximeter it is sad. I think we need to advocate for people to get a pulse oximeter, and this is part of this discussion here.” – Dr. Zipporah Gathuya

This month, leading anesthesia providers from across the world shared their experiences on issues relating to pulse oximetry impact in anesthesia care, remaining gaps in oximetry access and identified priorities for safe anesthesia care going forward – including the issue of pulse oximetry accuracy in darker skin tones.

This event – Bridging the Gap: Pulse Oximetry and Safer Anesthesia – was hosted by the Smile Train-Lifebox Safe Surgery and Anesthesia Initiative and featured Dr. Susana Abrego, Dr. Reshma Ambulkar, Dr. Zipporah Gathuya, Dr. Bertille Ki, Mubarak Mohamed, and Dr. Mary Nabukenya who chaired the event. 

Speakers discussed the benefits of pulse oximetry and mentioned stories about patients who survived because a pulse oximeter was used in their case, and others who could have survived if a pulse oximeter had been available. The reality of having access to a pulse oximeter is that this small piece of medical equipment saves lives.

“We could have lost this child casually, and if we had had a pulse oximeter, we would have realized the desaturation and we could have resolved the situation. I’m telling you that anyone could have detected the error and corrected it … oximetry improves patient safety. Complications may occur, but with oximetry, we will detect anomalies fairly quickly and we will be able to correct them,” Dr. Ki recalled.

“Pulse oximetry improves patient safety. Complications may occur, but with oximetry, we will detect anomalies fairly quickly and we will be able to correct them,” Dr. Ki noted.

“One of the greatest things a pulse oximeter does is provide the anesthesia provider with a peace of mind. I think for patient safety and anesthesia provision, the inclusion of pulse oximetry has made a tremendous impact on the outcomes and the safety of anesthesia,” Dr. Gathuya said, highlighting why many more people now are exploring anesthesia as a career.

The critical role of pulse oximetry during COVID-19 was also discussed. Pulse oximeters were used as a diagnostic tool and for ongoing care of COVID patients.

“The main problem with COVID-19 is lung issues. It is therefore even more important to have a pulse oximeter. Sometimes, the patients were doing fine, but when we applied the pulse oximeter we found out that the saturation was not enough,” Dr. Abrego said, adding that, “With COVID-19, this oximeter was even more important. We had patients without pulse oximeters and we were walking almost in the dark.”

Some of the speakers noted the role Lifebox has played in distributing pulse oximeters during COVID-19 and highlighted the impact these distributions have had.

Mr. Mohamed emphasized the difference made by a distribution of pulse oximeters during COVID-19, saying that, “We were able to send this donation to all the hospitals in Somaliland and do the training. This has allowed us to fight COVID-19; and when we received these oximeters, things really changed.”

As Dr. Nabukenya noted, “If nothing else, COVID-19 has helped us put out the word that pulse oximetry is very important. Everyone knows about pulse oximetry now.”

The discussion also highlighted remaining barriers to providing comprehensive anesthesia care and strategies to address the issue, including increasing access to pulse oximetry, delivering education to increase awareness levels and patient safety, and scaling National Surgical, Obstetric and Anesthesia Plans (NSOAPs).

“Once we have the pulse oximeters and the training that go with the pulse oximeters, a lot of the barriers will be addressed. We must advocate that people need pulse oximeters, not only in the OR but also in other areas,” Dr. Gathuya noted.

Dr. Abrego pointed out that, “We cannot have a patient who is sick without providing pulse oximetry monitoring; and so if the quantity increases, it could transform things, and we see that it is absolutely necessary. When these oximeters are distributed, we see the evolution in different places and we need more devices.”

Dr. Ambulkar noted the shortage of the anesthesia workforce in India and the need to prioritize the training of new anesthesia providers, “In my country, we have a severe shortage of trained anesthetists; we are around 50 to 60 thousand, whereas the need is over 200 thousand.”

Dr. Gathuya spoke about the need for an affordable, high-quality capnography device. This, she noted, is one of the key areas of the collaboration Smile Train-Lifebox Initiative. Building on the specifications released by the World Federation of Societies of Anesthesiologists, the capnography device in development will provide a critical piece of medical equipment to hospitals around the world.

“What we have done is we have gone through a process of looking for a capnography device that is affordable. We have gone through a whole process of identifying a monitor that is able to withstand and give accurate data for anesthesia providers. Watch this space.” Dr. Gathuya said.

The conversation concluded with the last words from the speakers. They mentioned how important it is to increase access and training for pulse oximetry.

“I believe that every patient has a right to safe anesthesia, and I think there should be minimal standards set by each country wherein a pulse oximeter should be a must,” Dr. Ambulkar said, adding that more training is needed for providers, especially in rural areas because “education is the basis of delivering safe anesthesia.”

“Pulse oximeters are very important. We can’t provide anesthesia if we don’t have a pulse oximeter. So, I will encourage everyone to use the Lifebox Learning Network to learn about pulse oximetry for free. The website is very easy to use and really helpful. You can do it anytime, anywhere. We must work together on the same side to fill the gap for the five billion people who don’t have access to safe surgery,” Mr. Mohamed concluded.

To access Lifebox’s free online course on Pulse Oximetry in English, French, or Spanish visit Lifebox Learning Network. For more information about the Lifebox-Smile Train pulse oximeter visit here.