A coalition of global health organizations, including Lifebox, Smile Train, the World Federation of Societies of Anaesthesiologists (WFSA), and the South African Society of Anaesthesiologists (SASA), have joined forces to address a critical gap in anesthesia safety: the lack of capnography in low-resource settings, a situation endangering countless lives.
At a press conference during the All Africa Anaesthesia Congress in Johannesburg this week, these organizations signed an action letter urging the inclusion of capnography as essential monitoring equipment in anesthesia guidelines.
“Including capnography as essential monitoring equipment is a vital step towards enhancing patient safety during surgery,” said Dr. Elizabeth Igaga, Director of Programs Safety at Smile Train. “By advocating for its integration into anesthesia guidelines, we are setting a new standard for safer surgical care, ensuring that every patient, regardless of location, has access to life-saving technology.”
While capnography has been widely used in high-income countries for over three decades, its introduction in the United States in 1991 led to a dramatic reduction in anesthesia-related complications and deaths. However, in low-resource settings, capnography remains largely unavailable, with studies showing up to a 100% gap in its availability in low-income countries.
Capnographs are crucial tools for detecting anesthesia-related complications, such as the misplacement of the breathing tube supplying oxygen to the patient. Without an oxygen supply, patients can suffer catastrophic harm in minutes.
“A capnograph is not just a tool—it’s an essential tool,” emphasized Dr. Tihitena Negussie, Global Clinical Director of Lifebox. “By integrating capnography into the standard practice of anesthesia worldwide, particularly in low-resource settings where I work, we can prevent countless avoidable complications and save lives. This coalition and the signing of this action letter represent a crucial moment in our collective effort to improve surgical safety.”
The action letter calls on the World Health Organization (WHO) and national decision-makers to accelerate the adoption of capnography in low-resource settings by:
- Upgrading capnography in the WHO-WFSA International Standards for a Safe Practice of Anesthesia from “recommended” to “highly recommended.”
- Including capnography alongside pulse oximetry in the WHO Surgical Safety Checklist as required equipment for safe surgery.
- Incorporating capnography as essential in national anesthesia guidelines.
“The WFSA is committed to advancing anesthesia safety worldwide, and capnography is a cornerstone of that mission,” said Professor Daniela Filipescu, President of WFSA. “Upgrading capnography’s status in global guidelines is necessary to protect patients and empower anaesthesiologists to provide the best possible care in any setting.”
The event saw participation from ministries of health, professional societies, hospitals, and anaesthesiologists from across Africa and beyond, marking a unified effort to ensure safer anesthesia practices and significantly improve health outcomes in low-resource settings.
“As anaesthesiologists, our primary responsibility is the safety of our patients,” noted Professor Sean Chetty, President of SASA. “The widespread adoption of capnography in low-resource settings will bring us closer to a world where safe anesthesia is a reality for all. Today’s agreement signifies a crucial advancement towards making this life-saving tool available where it is needed most.”
The scarcity of capnography in low-resource settings has been attributed to its high cost and the lack of devices suited to specific local needs. In response, Smile Train and Lifebox launched the Smile Train-Lifebox Capnograph, a high-quality, user-friendly, and affordable device designed for low-resource environments.
The initiative, in collaboration with WFSA and the Global Capnography Project (GCAP), also developed a comprehensive training package for anesthesia providers. This year, 350 Smile Train-Lifebox Capnographs will be distributed in Benin, Ethiopia, the Philippines, and Uganda.