The world has the knowledge to make anesthesia safer, but too often it’s the basics that are missing where the need is greatest. We’re talking about perioperative patient safety in low- and middle-income countries (LMICs), where a smaller share of surgical volume can still carry a massive share of perioperative death and disability. That imbalance isn’t inevitable, and it isn’t solved by one tool or one training course. It changes when systems change. We walk through the biggest systemic barriers starting with anesthesia workforce shortages and the downstream effects on access, delays, and confidence in care. We also dig into national surgical, obstetric, and anesthesia plans (NSOAPs) and how partnerships with organizations like the World Health Organization and the World Federation of Societies of Anesthesiologists can help countries set targets, build capacity, and track progress. From there, we get painfully practical: monitors, oxygen, essential medicines, and rescue drugs. We discuss the WHO Surgical Safety Checklist, what makes implementation succeed, and why the WFSA International Standards for a Safe Practice of Anesthesia matter as both a minimum safety floor and a roadmap for improvement. We close on a critical question for quality improvement everywhere: how do you build accountability when risk-adjusted outcomes data is hard to collect, and what solutions are most realistic? Subscribe for more anesthesia patient safety conversations, share this episode with a colleague, and leave a review so more clinicians can find the show.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/307-perioperative-safety-in-low-and-middle-income-countries/© 2026, The Anesthesia Patient Safety Foundation

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