Global Health Coalition Advocates for Capnography Inclusion in Anesthesia Guidelines

A coalition of global health organizations has called for the inclusion of capnography as essential monitoring equipment in anesthesia guidelines. The coalition, spearheaded by Lifebox, Smile Train, the World Federation of Societies of Anaesthesiologists (WFSA), and the South African Society of Anaesthesiologists (SASA), issued an action letter during a press conference at the ALL Africa Anaesthesia Congress in Johannesburg, South Africa. This initiative seeks to address a critical gap in anesthesia safety, particularly in low-resource settings where the lack of capnography is endangering countless lives.

Capnography, a technique used to measure the concentration of carbon dioxide (CO2) in exhaled breath, has been a standard in high-income countries for over three decades. Since its introduction in the United States in 1991, it has been instrumental in reducing anesthesia-related complications and fatalities. Despite its proven benefits, capnography remains largely unavailable in most low-resource settings, where it could make a significant difference in patient outcomes.

Dr. Elizabeth Igaga, Director of Programs Safety at Smile Train, emphasized the critical need for capnography in her remarks at the press conference. “By advocating for its integration into anesthesia 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,” she said. The call to action highlights the disparity between the availability of capnography in high-income and low-income countries, where research shows a 100% gap between the need for and the availability of this crucial equipment.

The primary function of a capnograph is to detect misplacement of the breathing tube supplying oxygen to the patient—a leading cause of anesthesia-related complications and deaths in low-resource settings. Without adequate oxygen supply, a patient can suffer severe harm within minutes. Dr. Tihitena Negussie, Global Clinical Director of Lifebox, underlined the importance of capnography, stating, “A capnograph is not just a tool—it’s an essential tool. By integrating capnography into the standard practice of anesthesia worldwide, particularly in low-resource settings where I work, we can prevent countless avoidable complications and save lives.”

The action letter calls on the World Health Organization (WHO) and national decision-makers to accelerate the adoption of capnography through three key actions:

Upgrade Capnography Status: Elevate the status of capnography in the WHO-WFSA International Standards for a Safe Practice of Anesthesia from “recommended” to “highly recommended.”
Include in Surgical Safety Checklist: Add capnography alongside pulse oximetry in the WHO Surgical Safety Checklist as required equipment for safe surgery.
Incorporate in National Guidelines: Integrate capnography as essential in national anesthesia guidelines.

Professor Daniela Filipescu, President of the World Federation of Societies of Anaesthesiologists (WFSA), expressed strong support for these changes. “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,” she stated.

The coalition’s push for capnography is supported by a broad range of stakeholders, including ministries of health, professional societies, hospitals, and individual anaesthesiologists from across Africa and beyond. Their collective effort aims to ensure that safer anesthesia practices become a reality for all patients, particularly in underserved regions.

The absence of capnography in many low-resource settings has often been attributed to its high cost and the lack of devices tailored to specific local needs. In response, Smile Train and Lifebox have introduced the Smile Train-Lifebox Capnograph—an affordable, high-quality device designed to meet the needs of low-resource environments. This capnograph boasts a sturdy construction and long battery life, making it well-suited for challenging conditions.

Moreover, to support the effective use of capnography, the initiative has developed a comprehensive training package for anesthesia providers. This includes educational resources and hands-on training to ensure that healthcare professionals are well-equipped to use the new technology. As part of this effort, 350 Smile Train-Lifebox Capnographs will be distributed this year to hospitals in Benin, Ethiopia, the Philippines, and Uganda.

The coalition’s actions represent a pivotal moment in the global effort to improve surgical safety. By advocating for the widespread adoption of capnography, they aim to bridge the gap in anesthesia care between high-income and low-resource settings, ultimately saving lives and enhancing patient safety worldwide. The inclusion of capnography in anesthesia guidelines is not merely a recommendation but a crucial step towards achieving universal standards of care in surgery.