Global health organizations unite to address capnography gap in anesthesia

Johannesburg, South Africa | THE INDEPENDENT | A coalition of leading global health organizations has joined forces to address a critical gap in anaesthesia safety: the lack of capnography in low-resource settings. At the ALL-Africa Anaesthesia Congress, organizations including Lifebox, Smile Train, the World Federation of Societies of Anaesthesiologists (WFSA), and the South African Society of Anaesthesiologists (SASA) signed an action letter calling for the inclusion of capnography as essential monitoring equipment in anaesthesia guidelines.

Capnography, a device used to measure the level of carbon dioxide in exhaled breath, is a vital tool for preventing anaesthesia-related complications and deaths. Despite its widespread use in high-income countries, capnography remains largely unavailable in many low-resource settings, putting countless patients at risk.

The coalition’s action letter urges the World Health Organization (WHO) and national decision- makers to take immediate steps to increase the adoption of capnography in these settings. This includes upgrading capnography’s status in WHO guidelines, incorporating it into the WHO Surgical Safety Checklist, and including it as essential equipment in national anaesthesia 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 anaesthesia guidelines, we are not only setting a new standard for safer surgical care but also ensuring that every patient, regardless of where they are, has access to life-saving technology,”

Capnography has been used widely in operating rooms in high-income countries for over three decades. Its introduction in the United States in 1991 led to a dramatic decline in anaesthesia- related complications and deaths. Yet, capnography remains largely unavailable across most low- resource-setting operating rooms, with research showing there is often a 100% gap between the need for capnography and its availability in low-income countries.

“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 anaesthesia 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 coalition’s action letter urges the World Health Organization (WHO) and national decision- makers to take immediate steps to increase the adoption of capnography in these settings. This includes upgrading capnography’s status in WHO guidelines, incorporating it into the WHO

Surgical Safety Checklist, and including it as essential equipment in national anaesthesia guidelines.

“The WFSA is committed to advancing anaesthesia safety worldwide, and capnography is a cornerstone of that mission,” stated Professor Daniela Filipescu, President of the World Federation of Societies of Anaesthesiologists (WFSA).

“The upgrade of capnography’s status in global guidelines is necessary to protect patients and empower anaesthesiologists to provide the best possible care in any setting,”

Ministries of health, professional societies, hospitals, and individual anaesthesiologists from across Africa and beyond participated in the signing of the action letter, marking a unified effort to ensure safer anaesthesia 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 the South African Society of Anaesthesiologists.

“The widespread adoption of capnography in low-resource settings will bring us closer to a world where safe anaesthesia is a reality for all. Today’s agreement signifies a crucial advancement towards making this life-saving tool available where it is needed most,”

To address the high cost and scarcity of capnography devices in low-resource settings, Smile Train and Lifebox have developed the Smile Train-Lifebox Capnograph, an affordable and durable device designed for these environments. The initiative has also developed a comprehensive training package for anaesthesia providers.

The coalition’s efforts represent a significant step towards ensuring safer anaesthesia practices and improving health outcomes in low-resource settings. By advocating for the widespread adoption of capnography, these organizations aim to create a world where safe anaesthesia is a reality for all.