However well trained you are as an anaesthetist, your ability to provide safe anaesthesia is completely dependent on the availability of the drugs, oxygen supply and equipment in your hospital. Drugs and oxygen must be correctly ordered and stored and equipment kept in safe working order by regular cleaning, maintenance and checks. Hospitals that do not follow these basic requirements will soon fail to provide safe anaesthesia.

The items of equipment listed in the tables on pages 15–2 to 15–4 are those necessary for provision of a service of resuscitation, acute care and emergency anaesthesia, at three levels, in a country with a limited health budget.

General medical or surgical equipment items are not included. Items in square brackets are alternatives or optional extras. “IVI (intravenous infusion) equipment” means everything needed to put up a drip and give an intravenous drug, including:

THE INTENSIVE CARE UNIT

Referral hospitals usually have an intensive care unit (ICU). However, facilities for intensive care should be available in every hospital where surgery and anaesthesia are performed.

At the simplest level, the ICU is a ward that has a better standard of nursing and is better equipped than a general ward. While both medical and surgical cases will be admitted there, the ICU is particularly important for the postoperative care of major or complicated surgical cases and is usually located near the operating room. If facilities allow, full monitoring and ventilation may continue after the operation, but for a much longer period. In most hospitals, over 70% of ICU admissions will be postoperative surgical patients.

Equipment for the ICU
The ICU does not necessarily need to have ventilators or other expensive machines. An ICU might be a ward where:

The monitoring of the patient all night long is the deciding factor in the success or failure of the ICU. Another important feature is whether staff take action when the measurements or observations show that something is wrong.

The provision of one or more simple, reliable electric ventilators (not gas or oxygen dependent) will double the usefulness of a basic ICU. Small, portable mains/battery ventilators with integral compressors are available, although they are relatively expensive.

The pulse oximeter
The pulse oximeter is the most widely used physiological monitoring device. It is especially useful in clinical anaesthesia and in the ICU and is simple to use. Unfortunately, capital costs are still very high, and sustainability is poor because of electronic failures and the short life span and high cost of new finger probes. The expected lifetime is probably only 3–4 years and many probes will need to be replaced during this time.

The pulse oximeter should be the minimum standard of monitoring in every operating room where regular major surgery is carried out.