A Safe-Anesthesia Innovation for Emergency and Life-Improving Surgeries When no Anesthetist is Available: A Descriptive Review of 193 Consecutive Surgeries

World J Surg. 2015 Sep;39(9):2147-52. doi: 10.1007/s00268-015-3118-1.

Abstract

Background: The worldwide human resource gap in anesthesia services often presents a barrier to accessing life-saving and life-improving surgeries. This paper assessed the impact of a ketamine anesthesia package, Every Second Matters-Ketamine (ESM-Ketamine)™, for use in emergency and life-improving surgeries by non-anesthetist clinicians in a resource-limited setting when no anesthetist was available.

Methods: We analyzed prospectively collected data from 193 surgeries constituting a pilot implementation of the ESM-Ketamine package, among three sub-district hospitals in Western Kenya. The study population comprises patients who required emergency or life-improving surgery when no anesthetist was available. Non-anesthetist clinicians in three sub-district hospitals underwent a 5-day training course in ESM-Ketamine complemented by checklists and an ESM-Ketamine Kit. Data were collected prospectively every time the ESM-Ketamine pathway was invoked. The training cases, although primarily tubal ligations, were included. The primary outcome measures centered on capturing the ability to safely support emergency and life-improving surgeries, when no anesthetist was available, through invoking the ESM-Ketamine pathway. The registry was critically examined using standard descriptive and frequency analysis.

Results: 193 surgical procedures were supported using the ESM-Ketamine package by five ESM-Ketamine trained providers. Brief (<30 s) patient desaturation below 92% and hallucinations occurred in 16 out of 186 (8.6%) and 23 out of 190 patients (12.1%), respectively. There were no reported major adverse events such as death, prolonged desaturations (over 30 s), or injury resulting from ketamine use.

Conclusion: This study provides promising initial evidence that the ESM-Ketamine package can support emergency and life-improving surgeries in resource-limited settings when no anesthetist is available.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia / adverse effects
  • Anesthesia / methods*
  • Anesthesiology* / education
  • Anesthetics, Dissociative / administration & dosage*
  • Anesthetics, Dissociative / adverse effects
  • Checklist
  • Child
  • Child, Preschool
  • Developing Countries*
  • Emergencies
  • Hallucinations / chemically induced
  • Health Resources
  • Humans
  • Infant
  • Infant, Newborn
  • Kenya
  • Ketamine / administration & dosage*
  • Ketamine / adverse effects
  • Middle Aged
  • Oximetry
  • Oxygen / blood
  • Pilot Projects
  • Workforce
  • Young Adult

Substances

  • Anesthetics, Dissociative
  • Ketamine
  • Oxygen