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

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.