Global Surgery and Anesthesia Manual: Providing Care in Resource-limited Settings

760 Pages·2015·0.33 MB·English

by  Meara

GLOBAL
SURGERY
AND
ANESTHESIA
MANUAL
Providing Care in Resource-Limited Settings
TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk
GLOBAL
SURGERY
AND
ANESTHESIA
MANUAL
Providing Care in Resource-Limited Settings
Edited by
John G. Meara
Craig D. McClain, David P. Mooney, Selwyn O. Rogers, Jr
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2015 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20140818
International Standard Book Number-13: 978-1-4822-4731-2 (eBook - PDF)
This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable
data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.
The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them
and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of
the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medi-
cal science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the
relevant national drug formulary and the drug companies’ printed instructions, and their websites, before administering any of the drugs recommended
in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole
responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors
and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if
permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may
rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic,
mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or
retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact
the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides
licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment
has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation
without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Contents
Foreword .................................................................................................................................................................................................ix
Preface .................................................................................................................................................................................................xiii
Authors ...................................................................................................................................................................................................xv
Commentators ......................................................................................................................................................................................xxi
Editors ..................................................................................................................................................................................................xxv
Section I Introduction
1. The Global Burden of Surgical Disease .......................................................................................................................................3
K. A. Kelly McQueen
Commentator: Zipporah Gathuya
2. Ethical Considerations ...................................................................................................................................................................7
David B. Waisel and Caris Grimes
Commentator: Wangari Nyaga
3. Developing Surgical Capacity: Models of Implementation ......................................................................................................13
Regan Bergmark, Wendy Williams, Johanna N. Riesel, Doreen Nakku, and Mack Cheney
Commentators: Nobhojit Roy, Nakul Raykar
Section II Anesthesia
4. Preparing for a Trip: OR Management .....................................................................................................................................23
Craig D. McClain
Commentator: Clover Ann Lee
5. Pharmacology of Commonly Used Drugs ..................................................................................................................................27
Leal G. Segura
Commentators: Edouard Uwamahoro, Denise M. Chan
6. Regional Anesthesia .....................................................................................................................................................................37
Christopher S. Lee and Navil F. Sethna
Commentator: Alexandra Torborg
7. Preoperative Evaluation ..............................................................................................................................................................51
Cynthia S. Tung
Commentators: Francoise Nizeyimana, Denise M. Chan
8. Intraoperative Management ........................................................................................................................................................61
Terrance A. Yemen
Commentators: Francoise Nizeyimana, Denise M. Chan
9. Postoperative Care: PACU and ICU ..........................................................................................................................................77
Traci A. Wolbrink and Martin Zammert
Commentators: Francoise Nizeyimana, Denise M. Chan
10. Resuscitation and Approach to Crisis Situations ......................................................................................................................89
Ann T. Hau and Craig D. McClain
Commentators: Edouard Uwamahoro, Denise M. Chan
v
vi Contents
Section III Non-Trauma
11. Chest ..............................................................................................................................................................................................99
Abraham Lebenthal and Alexi C. Matousek
Commentator: Koffi Herve Yangni-Angate
12. Acute Abdomen ..........................................................................................................................................................................111
Reinou S. Groen and Adam L. Kushner
Commentators: Okao Patrick, Louis-Franck Telemaque, Ntakiyiruta Georges
13. Stomach .......................................................................................................................................................................................119
David S. Shapiro
Commentator: Ntakiyiruta Georges
14. Liver, Pancreas and Gall Bladder .............................................................................................................................................131
Kelly Hewitt and Raymond R. Price
Commentators: Jigjidsuren Chinburen, Tsiiregzen Enkh-Amgalan
15. Spleen ...........................................................................................................................................................................................147
Mallory Williams, Quyen D. Chu, and Selwyn O. Rogers
Commentators: Ndukauba Eleweke, Ntakiyiruta Georges, Okao Patrick
16. Appendicitis ................................................................................................................................................................................163
Vladimir P. Daoud and Ibrahim M. Daoud
Commentators: Edgar Rodas, Edgar B. Rodas
17. Hernia ..........................................................................................................................................................................................169
Joaquim M. Havens
Commentators: Edgar Rodas, Edgar B. Rodas
18. Colon and Rectum ......................................................................................................................................................................177
Allison F. Linden and Kathryn Chu
Commentator: Thandinkosi E. Madiba
19. Anus and Rectum .......................................................................................................................................................................183
Joel E. Goldberg
Commentator: Thandinkosi E. Madiba, Ntakiyiruta Georges
20. Laparoscopy ................................................................................................................................................................................195
Gabriela M. Vargas and Raymond R. Price
Commentator: Sergelen Orgoi
21. Breast Cancer .............................................................................................................................................................................211
Lisa A. Newman, Marcel Bayor, Evelyn Jiagge, Der Muonir Edmund, and Mawuli Gyakobo
Commentators: Ouyang Lizhi, Ruth Damuse
22. Obstetrics ....................................................................................................................................................................................219
Reinou S. Groen and Adam L. Kushner
Commentator: Bomi Ogedengbe
23. Gynecology ..................................................................................................................................................................................247
Felicia Lester and Sierra Washington
Commentator: Tarek Meguid
24. Genitourinary Surgery ..............................................................................................................................................................267
Marc D. Manganiello and Jill Buckley
Commentators: E. Oluwabunmi Olapade-Olaopa, Thaim Buya Kamara
Contents vii
25. Neurosurgery ..............................................................................................................................................................................281
Benjamin C. Warf
Commentator: John Mugamba
26. Otorhinolaryngology ..................................................................................................................................................................291
Robert M. Boucher
Commentator: Wakisa Mulwafu
27. Thyroidectomy ............................................................................................................................................................................317
Robert M. Boucher
Commentator: Emmanuel R. Ezeome
28. Ophthalmology ...........................................................................................................................................................................329
Matthew C. Bujak and Geoffrey Tabin
Commentator: John Nkurikiye
29. Dentistry ......................................................................................................................................................................................345
Joel S. Reynolds and Robert P. Horne
Commentator: Rose Dina Premier
30. Orthopedic Surgery ...................................................................................................................................................................363
George S.M. Dyer
Commentator: Ankur B. Bamne
31. Pediatric Surgery .......................................................................................................................................................................371
Doruk Ozgediz and Emmanuel A. Ameh
Commentator: Milliard Derbew
32. Oncology ......................................................................................................................................................................................395
T. Peter Kingham and Olusegun Alatise
Commentator: Ruth Damuse
33. Infectious Diseases .....................................................................................................................................................................401
Gita N. Mody, Sachita Shah, and Robert Riviello
Commentators: Samuel Abimerech Luboga, Peter M. Nthumba
34. Soft-Tissue Coverage and Flaps ................................................................................................................................................409
Christopher D. Hughes and Nadine Semer
Commentators: Jorge Palacios, Chona Thomas, Charles Furaha, Christian Paletta
35. Skin Grafts ..................................................................................................................................................................................419
Ingrid Ganske and Jennifer Wall
Commentators: Jorge Palacios, Charles Furaha, Christian Paletta
36. Wound Care ................................................................................................................................................................................431
Helena O.B. Taylor and Stephen R. Sullivan
Commentators: Ntakiyiruta Georges, Sterman Toussaint, Okao Patrick, Okechukwu O. Onumaegbu
Section IV Trauma
37. Disaster Management ................................................................................................................................................................443
Susan Miller Briggs and Guy Lin
Commentator: Emmanuel Kayibanda
38. Initial Evaluation of the Trauma Patient .................................................................................................................................455
William P. Schecter
Commentator: Sebastian O. Ekenze
viii Contents
39. Amputation .................................................................................................................................................................................463
Samuel C. Schecter and Nikolaj Wolfson
Commentators: L.O.A. Thanni, Michael O. Ogirima
40. Burns ...........................................................................................................................................................................................477
Jennifer Wall, Gita N. Mody, and Robert Riviello
Commentators: Nivaldo Alonso, Daniel Chimutu, David Morton
41. Thoracic Trauma .......................................................................................................................................................................493
Abraham Lebenthal and Alexi Matousek
Commentators: Koffi Herve Yangni-Angate, Ikechukwu A. Nwafor
42. Abdominal Trauma ....................................................................................................................................................................501
Alexi C. Matousek, Thomas G. Weiser, and Selwyn O. Rogers
Commentators: Rodolphe R. Eisenhower Jean-Louis, Emmanuel Kayibanda
43. Urologic Trauma ........................................................................................................................................................................513
Kristen R. Scarpato, Hiep T. Nguyen, and Richard N. Yu
Commentators: Demberelnyambuu Batsukh, E. Oluwabunmi Olapade-Olaopa, Emile Rwamasirabo
44. Neurosurgical Trauma ..............................................................................................................................................................523
Benjamin C. Warf
Commentator: John Mugamba
45. Maxillofacial Trauma ................................................................................................................................................................531
Daniel J. Meara
Commentators: Bin Song and C.C. Uguru
46. Ophthalmic Trauma ..................................................................................................................................................................555
Matthew C. Bujak, Geoffrey C. Tabin, and Benjamin J. Thomas
Commentators: Ifeoma Ezegwui, John Nkurikiye
47. Soft-Tissue Injuries of the Face .................................................................................................................................................567
Christopher D. Hughes and Julian J. Pribaz
Commentator: Nivaldo Alonso
48. Spinal Trauma ............................................................................................................................................................................573
Andrew K. Simpson and Mitchel B. Harris
Commentator: Ankur B. Bamne
49. Upper Extremity Trauma..........................................................................................................................................................577
Paul T. Appleton and Joseph P. DeAngelis
Commentator: Ankur B. Bamne
50. Hand Trauma .............................................................................................................................................................................589
Simon G. Talbot and Amir H. Taghinia
Commentator: Nyengo Mkandawire
51. Lower Extremity Trauma .........................................................................................................................................................603
Paul T. Appleton, J. Kent Ellington, and John Y. Kwon
Commentator: Ankur B. Bamne
References ...........................................................................................................................................................................................623
Appendix: Safety, Security, and Survival Considerations for Healthcare Providers in Remote, Hostile, and
Disaster Areas .............................................................................................................................................................................649
Mykel Hawke
Index ....................................................................................................................................................................................................655
Foreword
Paul E. Farmer
In the spring of 2008, writing in World Journal of Surgery, Jim those living with (and dying from) AIDS and in dire poverty. But
Yong Kim and I—both internists with long experience in the by the year 2008, when Kim and I wrote, significant investments
delivery of health care in settings of poverty—referred to sur- in health care delivery were beginning to drop mortality due to
gery as “the neglected stepchild of global health.”1 We argued AIDS in many of these same settings, including the rural areas
that this was the case because the dominant means of financing in which most Africans lived. By the time this important and
surgical care excluded those in greatest need of such services. If long-overdue volume, Global Surgery and Anesthesia Manual,
anything, the term “neglected” was a euphemism, because all goes to press, the return on investments such as those made pos-
pathologies afflicting the world’s poorest were, by definition, sible by new programs (the two largest being the U.S. President’s
neglected: Emergency Plan for AIDS Relief and the Global Fund to Fight
AIDS, Tuberculosis, and Malaria, but these often spurred, in
The truth is even more unpleasant: within poor coun-
turn, increased national resources for programs to prevent and
tries, surgical services are concentrated almost wholly
treat these pathogens) is even more evident. Case-fatality rates
in cities and reserved largely for those who can pay
attributable to these three pathogens have plummeted and epi-
for them. In Haiti, for example, a community-based
demics have shrunk, as would be expected when both preven-
survey conducted in the 1980s suggested that rates of
tion and care are increased. In one striking example, we recently
caesarean delivery in a large area of southern Haiti
were close to zero; maternal mortality was pegged at reported that over the past decade Rwanda has witnessed the
1,400 per 100,000 live births. Yet among the affluent sharpest decrease in mortality ever recorded in human his-
of that same country, rates of caesarean delivery do not tory.2 By 2013, only 10 years into “the delivery decade,” both
vary much from those registered in the United States. prevention and care have been strengthened; life expectancy has
Careful scrutiny of local inequalities of risk and access resumed its upward trend in many of the most affected regions;
to care reveals that in poor countries, even minor surgi- and new HIV infections have at last started to decline.3 With
cal pathologies are often transformed through time and regards to AIDS, the prevention-versus-care debate has at last
inattention into lethal conditions. Congenital abnor- been improved to one about how best to integrate prevention and
malities such as cleft palate remain life-long afflictions care. This improvement in the terms of debate may be one of the
rather than pediatric surgical disease. In addition to chief returns on the investments of the past decade.
surgical abdomens, severe trauma (from road accidents If we are at the end of the delivery decade, was our 2008
more often than from intentional violence) and other diagnosis about surgery overly pessimistic? Alas, no. The term
potentially fatal pathologies remain a massive burden
“neglected stepchild” was, if anything, euphemistic. While long-
of untreated disease that weighs on the lives, and pro-
standing inattention to deaths due to epidemic disease has dimin-
ductivity, of the world’s bottom billion.1
ished somewhat, the same successes cannot yet be heralded for
The assessment seemed to have struck a chord among our sur- global surgical disease. To mix metaphors a bit, it was hard to
gical colleagues, in part because there had been, even by 2008, call for a renaissance, because prior efforts to make access to
significant advances in non-surgical care for people living both safe surgical care a priority for the poor were, beyond a few
with serious illness and in extreme poverty. But these advances short-term exceptions, too often linked to war or to natural disas-
were very recent ones, as we knew from our work with Partners ters, mostly still-born.
In Health, an organization we co-founded in the late 1980s, and But there is hope on the horizon. In the past several years, inter-
as academic physicians working and teaching in places like est in “global surgery” has experienced something of a growth
Haiti, Peru, Rwanda, and Lesotho. spurt, which has also led to a greater, if imperfect, understanding
What a difference a decade makes. Just look at the past one: by of the burden of surgical disease as well as increasing knowledge
the year 2003, the world’s leading infectious killer of young adults of who has access to surgical care that is both safe and indicated.
was acquired immunodeficiency syndrome (AIDS), which along Much of that knowledge is summarized in Global Surgery and
with an airborne illness fanned by epidemic human immunode- Anesthesia Manual, which allows me to repeat, with some cha-
ficiency virus (HIV), had led (along with several other pathogens grin, that surgery (along with effective therapy for malignancies,
and pathogenic forces, including divestment from public health which often includes surgical care and effective anesthesia, and
systems) to a massive reversal of public-health gains in many with major mental illness) remains a neglected stepchild even if
of the world’s poorest countries, especially in Africa. A mere things have started to look up. New information about the know-
decade ago, it’s easy to imagine that predictions of imminent do gap reminds us our previous assessment was euphemistic in
improvement might have been greeted with weary skepticism by part because it is not only the bottom billion or so who miss out.
ix