Kevin's Anesthesia Advice

The post below was authored by Kevin Nessari, a PGY-3 Anesthesiology Resident at Loma Linda University who spent 2wks volunteering in Haiti last month.

The anesthesia experience is unique and requires the constant ability to adapt to a disorganized system.  The patients are very grateful and the Haitian staff will do their best to help you if you try to get them involved.

Practical:

• NPO may not actually mean NPO.  I learned this the hard way…
• The translators are great for helping you with a preop assessment.
• Depending on the staff the PACU quality varies greatly.
• Anesthetic records come with the charts but are very basic.
• No temperature or C02 sensors are available in the OR.
• If a patient does not bring blood with them it will take about 4hrs for the family to go get it but the availability of the correct type is not for certain.
• Basic labs are available pre-op if needed as well as EKG and CXR.
• Work hours vary but be ready to work a few long shifts if you are the only provider there at night.  Usually enough anesthesia staff will be available during the day to run 3 rooms.
• Be flexible (see pic below).

Supplies:

• Most medicines are available with a few exceptions. 
• Supplies of fentanyl, succinylcholine, and antihypertensives are low.  
• Epi, atropine, ephedrine and phenylephrine are available but other pressors are hard to come by.  
• I couldn’t find any dantrolene. 
• Lots of spinal/epidural local and regional local was available but may decrease soon as it is being used heavily.

Equipment:

• There is a nerve stimulator and a few needles are available but I only found the 100mm variety.
• There is a syringe infusion pump but the number of 60cc syringes is low.
• Plenty of adult ET tubes, pediatric sizes are few, pediatric blades are hard to find but available.  
• There are a lot of broken blades and handles so having a spare set would not hurt.  
• LMA’s are available, but the supply of #4’s is decreasing.
• No warming devices or warm blankets are available.
• 3 OR rooms, 3 anesthesia machines of which none work well i.e. leaks and broken ventilator.  
• It is safe to bag the patient on each machine, I made sure all patients that required GA were breathing on their own as quickly as possible.
• One i-STAT machine is available in the hospital.
• Sterile drapes for spinals/regional are hard to come by.
• Electrical supply runs through a standard US type socket.

I hope this helps and good luck!