The chapter covers pre-op assessment in the context of limited availability to tests and investigations outlining the key considerations that should be made in assessing fitness for and appropriateness of surgery. Key aspects of consent within different cultural contexts are explored as well as important consent considerations for quality improvement and research projects. A practical approach to the assessment and management of pain in the context of limited availability of medications and trained staff is taken including the management of acute pain, non-surgical pain, pain related to cancer, chronic pain, and neuropathic pain. In the last section, key aspects of anaesthesia and resuscitation at high altitude are covered.