Establishing a congenital cardiac anesthesia service: challenges in a developing country

ABSTRACT

Congenital heart disease is the commonest congenital birth defect seen in low and middle income countries and definitive care requires highly sophisticated equipment, drugs, and above all a specially trained professional teams. Financially viable and sustainable congenital heart programs are a big challenge in these countries although examples of creative solutions do exist. Major challenges in establishing services are training, team building and staff retention. There is a lack of recognized fellowship programs as well as centers for training. Investment in a structured program is a cost effective solution for capacity building. One solution is to locate congenital cardiac service in a few strategic centers, with facilities of transport and accommodation which can then serve as recognized training centers. And which may cater to a number of peripheral referring centers. Cost containment strategies such as clinical protocols and checklists, economical alternatives for expensive drugs, minimization of blood and blood product transfusion, prevention of infection, efficient turnover time, and fast track extubation to reduce ICU and hospital length of stay are important for cost effective care