Understanding the practice of neuroanaesthesia across low- and middle-income countries (LMICs): a cross-sectional survey - 30/06/26

Doi : 10.1016/j.accpm.2026.101778

Charu Mahajan ^a,⁎ , Hemanshu Prabhakar ^a, Indu Kapoor ^a, Ritesh Lamsal ^b, Abhijit V Lele ^c, Samuel Ern Hung Tsan ^d, Jorge Mejia ^e, Cristiane Tavares ^f, Delphine Delali Grant ^g, Konstantin Popugaev ^h, Mani Kalaivani ⁱ, Ananya Abate ^j, Miguel Llano ^k, Walter Theiller ^l, Faraz Shafiq ^m, Sandra Spijkerman ⁿ, Martha Gómez-Ramírez ^o, Claudia Nino ^p, Hugo Sanchez ^q, Nophanan Chaikittisilpa ^r, Ahmad Rashad Akbari ^s, Madelayne A.M. Flores ^t, Aidos Konkayev ^u, Chann Myei ^v, Ina Cua ^w, Alexander Kulikov ^x, Oguzhan Arun ^y, Ibrahim Bello Galadima ^z, Wanning Yang ^aa, Gisela Maribel Llorente Mariñez ^ab, Safaa Hilal ^ac, George Njogu ^ad, Ganbold Lundeg ^ae, Victor Manuel Aquino Millan ^af, Yessica Ivon Terrazas Serrano ^ag, Puvanendiran Shanmugam ^ah, Dhania Santosa ^ai, Jehad Bander Ibrahim Abualbalol ^aj, Debora Forden Madyedye ^ak, Peter Agaba ^al, Dung Le Van ^am

^a Department of Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, India

^b Department of Anaesthesiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

^c Departments of Anesthesiology, Neurology and Neurological Surgery Harborview Medical Center, University of Washington, Seattle, WA, United States of America

^d Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Malaysia

^e Fundación Valle del Lili, University Hospital, Cali, Colombia

^f Hospital das Clínicas of University of São Paulo School of Medicine, Brazil

^g Department of Anaesthesia and Critical Care, Greater Accra Regional Hospital, Accra, Ghana

^h Department of Anaesthesia and Intensive Care Unit, National Research Institute of Surgery Named A.V. Vishnevsky, Moscow, Russia

ⁱ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

^j Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia, University of Botswana, School of Medicine, Gaborone, Botswana

^k Unidad de Cuidados Intensivos del Hospital de Especialidades de las FF.AA. Nro.1 de Quito, Ecuador, Universidad de las Fuerzas Armadas ESPE, Ecuador

^l Department of the Pain Medicine and Neuroanesthesiology Service, Sanatorio Trinidad Ramos Mejía, Buenos Aires, Argentina

^m Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan

ⁿ Department of Anaesthesiology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

^o Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Centro Médico Nacional La Raza, Mexico

^p Departamento de Anestesia, Fundacion Santafe de Bogota, Colombia

^q Department of Anesthesia, Hospital Nacional Mario Catarino Rivas, Cortes, San Pedro Sula, Honduras

^r Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol, Thailand

^s Ahmad Rashad Akbari – Department of Anesthesia, French Medical Institute for Mothers and Children hospital, Kabul, Afghanistan

^t Departamento de Anestesiologia, Hospital Petrolero de Obrajes, La Paz, Bolivia

^u Department of Anesthesiology and Intensive Care, Astana Medical University, National Scientific Center of Traumatology and Orthopedia named after N. Batpenov, Astana, Kazakhstan

^v Department of Anaesthesia and Intensive Care, Defence Services General Hospital, Yangon, Myanmar

^w Department of Anesthesia, St. Luke’s Medical Center Quezon City, Quezon City, Philippines

^x Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia

^y Selcuk University Faculty of Medicine Department of Anesthesiology and Reanimation, Konya, Turkey

^z Department of Anesthesiology and Intensive Care, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria

^aa Department of Anesthesiology, Peking University School and Hospital of Stomatology; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

^ab Departamento de Anestesiologia, Centro Cardio-Neuro-Oftalmológico y Transplante CECANOT, CiudadSanitaria Dr Luis E. Aybar Centro de Medicina avanzada Dr. Abel Gonzalez, Hospital Docente Dr. Padre Billini, Santo Domingo, Dominican Republic

^ac Department of Anesthesiology, ICU and Pain management, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt

^ad Department of Anaesthesia, Kenyatta National Hospital, Nairobi, Kenya

^ae Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia

^af Departamento Central de Anestesia Instutute: Facultad de Ciencias Médicas, Universidades nacional de Asunción, Hospital de Clínicas, San Lorenzo, Paraguay

^ag Departamento de Anestesiología, Hospital Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru

^ah Department of Neuroanaesthesia and Neurocritical Care, National Hospital-Kandy, Kandy, Sri Lanka

^ai Department of Anesthesiology and Reanimation, Dr Soetomo General Academic Hospital, Surabaya, Indonesia

^aj Department of Anesthesia, Atbara Teaching Hospital, Atbara, River Nile State, Sudan

^ak Anesthesiology and Critical Care Department, Bugando Medical Centre, Consultant and Teaching Hospital Lake Zone, Mwanza, Tanzania

^al Department of Anaesthesia and Intensive Care, Mulago National Superspecialized Referral Hospital, Kampala, Uganda

^am Department of Anesthesia, Cho Ray Hospital, Ho Chi Minh city, Vietnam

^⁎ Corresponding author.

Abstract

Background

Understanding the challenges in resource-limited settings is crucial for improving the quality of care, building capacity, and facilitating international collaboration in neurosurgical care. We conducted this survey with the aim of assessing and describing the current practices, challenges, training, and infrastructure associated with neuroanaesthesia across LMICs, to identify key gaps.

Methods

This cross-sectional survey collected data on training, education, details about clinical practice, agents used, availability of equipment and resources, and challenges involved. Data were analysed using descriptive statistics, and comparisons were made across different geographical regions and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)].

Results

A total of 453 anaesthesiologists from 38 LMICs took the survey. About 54.9% (133/242) of respondents from UMICs reported the presence of an academic program for training in neuroanaesthesia, while 67.2% (45/67) of respondents from LICs do not have any facility for neuroanaesthesia training. Approximately 40.4% (183/453) of respondents have a recognized neuroanaesthesia course available at their institute. The availability of dedicated neuroanaesthetists was limited (69/453; 15.2%). Only 46.8% (212/453) of respondents were satisfied with the availability of critical neuroanaesthesia tools, and variation was observed across LMICs ( p < 0.001). The presence of a dedicated quality improvement program was reported by only 16.8% of the respondents.

Conclusion

This survey provides useful insight about the unmet needs and the opportunities for strengthening neuroanaesthesia practice in the LMICs.

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Keywords : Low-income countries, Middle-income countries, Neuroanesthesia, Quality improvement, Research, Resource-limited

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Vol 45 - N° 5

Article 101778- septembre 2026 Retour au numéro

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Understanding the practice of neuroanaesthesia across low- and middle-income countries (LMICs): a cross-sectional survey - 30/06/26

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