Global Health Leaders Unite to Improve Anaesthesia Safety in Low-Resource Settings

A coalition of prominent global health organizations has come together to tackle a critical issue in anaesthesia safety: the absence of capnography in low-resource environments. During the ALL-Africa Anaesthesia Congress, groups including Lifebox, Smile Train, the World Federation of Societies of Anaesthesiologists (WFSA), and the South African Society of Anaesthesiologists (SASA) signed an action letter advocating for the recognition of capnography as essential monitoring equipment in anaesthesia guidelines.

Capnography, which measures carbon dioxide levels in exhaled breath, is crucial for preventing complications and fatalities related to anaesthesia. Despite its widespread implementation in high-income countries, access to capnography remains limited in many low-resource settings, endangering countless patients.

The coalition’s letter calls on the World Health Organization (WHO) and national decision-makers to take immediate action to promote the use of capnography. This includes elevating its status in WHO guidelines, integrating it into the WHO Surgical Safety Checklist, and recognizing it as essential equipment in national anaesthesia protocols.

Dr. Elizabeth Igaga, Director of Programs Safety at Smile Train, emphasized the importance of this initiative: “Incorporating capnography as essential monitoring equipment is vital for enhancing patient safety during surgery. By advocating for its inclusion in anaesthesia guidelines, we aim to set a new standard for safer surgical care, ensuring that every patient has access to life-saving technology.”

Capnography has been a standard practice in operating rooms in high-income countries for over 30 years, significantly reducing anaesthesia-related complications since its introduction in the U.S. in 1991. However, research indicates a stark gap in its availability in low-resource settings, with many countries lacking this critical tool entirely.

Dr. Tihitena Negussie, Global Clinical Director of Lifebox, stated, “A capnograph is not just a tool—it’s an essential one. By integrating capnography into standard anaesthesia practices worldwide, especially in low-resource settings, we can prevent numerous avoidable complications and save lives. This coalition and the signing of this action letter mark a pivotal moment in our shared mission to enhance surgical safety.”

The action letter emphasizes the need for WHO and national authorities to prioritize capnography, reinforcing its role in safeguarding patients and empowering anaesthesiologists to deliver optimal care in any context.

Professor Daniela Filipescu, President of the WFSA, expressed the organization’s commitment to advancing anaesthesia safety globally: “Upgrading capnography’s status in global guidelines is essential for protecting patients and enabling anaesthesiologists to provide the highest level of care.”

The signing event saw participation from health ministries, professional societies, hospitals, and individual anaesthesiologists from across Africa and beyond, reflecting a unified effort to promote safer anaesthesia practices and improve health outcomes in resource-limited settings.

Professor Sean Chetty, President of the South African Society of Anaesthesiologists, noted, “As anaesthesiologists, our primary responsibility is patient safety. The widespread adoption of capnography in low-resource settings will bring us closer to a reality where safe anaesthesia is accessible to all. Today’s agreement is a crucial step toward making this life-saving tool available where it is needed most.”

To address the challenges posed by the high cost and scarcity of capnography devices, Smile Train and Lifebox have developed the Smile Train-Lifebox Capnograph—an affordable, durable solution designed specifically for low-resource settings. The initiative also includes a comprehensive training package for anaesthesia providers.

The coalition’s efforts represent a significant advancement in ensuring safer anaesthesia practices and enhancing health outcomes in low-resource environments. Through their advocacy for the widespread adoption of capnography, these organizations aim to create a future where safe anaesthesia is a reality for everyone.