To the Editor:—

We read with interest the article by Fisher et al.  1concerning quality improvement in anesthesia for the Operation Smile organization. The authors are to be congratulated for attempting to improve the overall quality of anesthesia care in the third world countries that Operation Smile helps by improving the lives of children with cleft lips and palates and orthopedic problems.

Having been part of the teams for the organization, we personally know some of the problems faced by the teams as pointed out in the article. If pulse oximetry is now a standard for intraoperative and postoperative units, this is a significant step forward for the anesthesia team (as having an extra anesthesia team member available to help with inductions and breaks). Another improvement would be to have a double-boarded pediatric anesthesiologist as a team member who is involved with the preoperative assessment, the postanesthesia care unit, and the emergencies that may occur both on the postoperative ward and in the operating room.

However, not mentioned is the realization that not all members of the anesthesia team are fully trained pediatric anesthesiologists. We make these suggestions only as a secondary point to the effort the authors have put forth to help improve the care of these children.

Fisher QA, Nichols D, Stewart F, Finley GA, Magee WP, Nelson K: Assessing pediatric anesthesia practices for volunteer medical services abroad. A nesthesiology 2001; 95: 1315–22