Pulse oximeters breathe life into surgery in poorer nations.

www.thelancet.com Vol 377 January 1, 2011 17 See Articles Lancet 2006; 376: 1055–61 With worldwide demand for surgery reaching an all time high, so attention has focused on outcomes of surgical procedures. Among the many things taken for granted in the operating theatre in high-income countries is the availability of good quality pulse oximeters—devices that monitor the level of oxygenation in a patient’s blood and alert the physician if oxygen concentrations drop below safe levels, allowing rapid intervention. The devices are essential in any setting in which a patient’s blood oxygenation is unstable, including routine operations, emergency and intensive care, and also hospital wards. Unsurprisingly, lowincome and middle-income countries have little or no access to such devices, and poor or non-existent training for the often low-quality devices they do have. Pulse oximeters use a fi nger probe to measure the oxygen saturation of haemoglobin in the peripheral circulation. The technology in its current form became available in the early 1980s, and by the early 1990s pulse oximeters were adopted as a standard of care in international anaesthesia. Today, 58 countries have established anaesthesia-monitoring standards, and all include pulse oximetry as a minimum requirement. The World Federation of Societies of Anaesthesiologists (WFSA) includes pulse oximeters as a minimum standard of care in all hospitals where surgery is undertaken. Introduction of these devices into developed countries such as the UK reduced death rates by 20 times, from one in 10 000 operations to one in 185 000. In stark contrast, anaesthesia mortality in low-income countries today has been reported to be as high as one in 133. A study published in 2010 by Gawande and colleagues in The Lancet showed that across sub-Saharan Africa, between 60% and 70% of operating theatres have no pulse oximeter, compared with a global average of 20%. Almost 100% of highincome country operating theatres possess these vital devices. This followed a 2009 study that showed