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Evaluation of a ketamine‐based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available
Author(s) -
Burke Thomas F.,
Nelson Brett D.,
Kandler Taylor,
Altawil Zaid,
Rogo Khama,
Imbamba Javan,
Odenyo Stella,
Pinder Leeya,
Lozo Svjetlana,
Guha Moytrayee,
Eckardt Melody J.
Publication year - 2016
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2016.06.024
Subject(s) - medicine , ketamine , laparotomy , anesthesia , cesarean delivery , surgery , pregnancy , biology , genetics
Abstract Objective To assess the safety of a ketamine‐based rescue anesthesia package to support emergency cesarean delivery and emergency laparotomy when no anesthetist was available. Methods A prospective case‐series study was conducted at seven sub‐county hospitals in western Kenya between December 10, 2013, and January 20, 2016. Non‐anesthetist clinicians underwent 5 days of training in the Every Second Matters–Ketamine (ESM‐Ketamine) program. A database captured preoperative, intraoperative, and postoperative details of all surgeries in which ESM‐Ketamine was used. The primary outcome measure was the ability of ESM‐Ketamine to safely support emergency operative procedures. Results Non‐anesthetist providers trained on ESM‐Ketamine supported 83 emergency cesarean deliveries and 26 emergency laparotomies. Ketamine was administered by 10 nurse‐midwives and six clinical officers. Brief oxygen desaturations (< 92% for < 30 s) were recorded among 5 (4.6%) of the 109 patients. Hallucinations occurred among 9 (8.3%) patients. No serious adverse events related to the use of ESM‐Ketamine were recorded. Conclusion The ESM‐Ketamine package can be safely used by trained non‐anesthetist providers to support emergency cesarean delivery and emergency laparotomy when no anesthetist is available.