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Burke TF, Mantena S, Opondo K, Orero S, Rogo K. A ketamine package for use in emergency cesarean delivery when no anesthetist is available: An analysis of 401 consecutive operations. Int J Gynaecol Obstet 2021; 158:377-384. [PMID: 34606101 PMCID: PMC9545139 DOI: 10.1002/ijgo.13965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/12/2021] [Accepted: 09/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of a ketamine-based anesthesia package to support emergency cesarean section when no anesthetist is available. METHODS A prospective case-series was conducted between December 11, 2013 and September 30, 2021 across nine sub-county hospitals in Kenya. Non-anesthetist healthcare providers undertook an evidence-based five-day training course. A structured instrument was used to collect preoperative, intraoperative, and postoperative data, and patients were contacted 6 months following the surgery to collect outcomes. The primary outcome measures were maternal and newborn survival and the ability of the ketamine package (ESM-Ketamine) to safely support cesarean deliveries. RESULTS A total of 401 emergency cesarean sections were performed using ketamine, administered by 54 non-anesthetist providers. All mothers survived to discharge. Brief oxygen desaturations were recorded among 33 (8.2%) mothers, and agitation and hallucinations occurred among 13 (3.2%). There were no maternal serious adverse events. At 6-month follow-up, 94.2% of mothers who could be reached reported no complaints. Additionally, 402 (92.4%) of the 435 operative births survived to discharge. CONCLUSION The ESM-Ketamine package can be used by trained non-anesthetist providers to support emergency cesarean sections when no anesthetist is available. Ketamine has significant potential to increase access to emergency cesarean deliveries in resource-limited settings.
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Affiliation(s)
- Thomas F Burke
- Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sreekar Mantena
- Departments of Statistics and Molecular & Cellular Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Kennedy Opondo
- Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Solomon Orero
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya.,Kenya Obstetrics and Gynecological Society, Nairobi, Kenya
| | - Khama Rogo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya.,Kenya Obstetrics and Gynecological Society, Nairobi, Kenya
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Lewandowski K, Kretschmer B, Schmidt KW. [175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"]. Anaesthesist 2021; 70:811-831. [PMID: 34529093 PMCID: PMC8444521 DOI: 10.1007/s00101-021-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 01/01/2023]
Abstract
The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.
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Affiliation(s)
- K Lewandowski
- Anästhesiologie und operative Intensivmedizin, Charité (extern), Berlin, Deutschland.
| | | | - K W Schmidt
- Zentrum für Ethik in der Medizin, Agaplesion Markus Krankenhaus, Frankfurt a. M., Deutschland
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Makin J, Suarez-Rebling D, Suarez S, Leone A, Burke TF. Operations supported by ketamine anesthesia in resource-limited settings: Surgeons’ perceptions and recommendations – Qualitative Study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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4
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Kols A, Kibwana S, Molla Y, Ayalew F, Teshome M, van Roosmalen J, Stekelenburg J. Factors Predicting Ethiopian Anesthetists' Intention to Leave Their Job. World J Surg 2018; 42:1262-1269. [PMID: 29110158 PMCID: PMC5895675 DOI: 10.1007/s00268-017-4318-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Ethiopia has rapidly expanded training programs for associate clinician anesthetists in order to address shortages of anesthesia providers. However, retaining them in the public health sector has proven challenging. This study aimed to determine anesthetists’ intentions to leave their jobs and identify factors that predict turnover intentions. Methods A nationally representative, cross-sectional survey of 251 anesthetists working in public-sector hospitals in Ethiopia was conducted in 2014. Respondents were asked whether they planned to leave the job in the next year and what factors they considered important when making decisions to quit. Bivariate and multivariable logistic regressions were conducted to investigate 16 potential predictors of turnover intentions, including personal and facility characteristics as well as decision-making factors. Results Almost half (n = 120; 47.8%) of anesthetists planned to leave their jobs in the next year, and turnover intentions peaked among those with 2–5 years of experience. Turnover intentions were not associated with the compulsory service obligation. Anesthetists rated salary and opportunities for professional development as the most important factors in decisions to quit. Five predictors of turnover intentions were significant in the multivariable model: younger age, working at a district rather than regional or referral hospital, the perceived importance of living conditions, opportunities for professional development, and conditions at the workplace. Conclusions Human resources strategies focused on improving living conditions for anesthetists and expanding professional development opportunities may increase retention. Special attention should be focused on younger anesthetists and those posted at district hospitals. Electronic supplementary material The online version of this article (doi:10.1007/s00268-017-4318-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrienne Kols
- Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, USA
| | - Sharon Kibwana
- Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, USA. .,Jhpiego Ethiopia, Kirkos Subcity, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia.
| | - Yohannes Molla
- Jhpiego Ethiopia, Kirkos Subcity, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia
| | - Firew Ayalew
- Jhpiego Ethiopia, Kirkos Subcity, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia
| | - Mihereteab Teshome
- Jhpiego Ethiopia, Kirkos Subcity, Kebele 02/03, House 693, Wollo Sefer, Addis Ababa, Ethiopia
| | | | - Jelle Stekelenburg
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.,Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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5
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Villegas S, Suarez S, Owuor J, Wuyke GM, Nelson BD, Imbamba J, Rogo D, Rogo K, Burke TF. Intraoperative awareness and experience with a ketamine-based anaesthesia package to support emergency and essential surgery when no anaesthetist is available. Afr J Emerg Med 2018; 9:S56-S60. [PMID: 30976503 PMCID: PMC6440926 DOI: 10.1016/j.afjem.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/20/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Five of the 7.2 billion people on earth have limited access to emergency and essential surgical procedures. The lack of safe, affordable and timely anaesthesia services are primary barriers to universal surgical coverage. The objective of this study was to assess intraoperative awareness when the 'Every Second Matters for Emergency and Essential Surgery - Ketamine' (ESM-Ketamine) package was used to support emergency and essential surgeries and painful procedures in rural Kenya when no anaesthetist was available. METHODS Forty-seven consecutive adult patients that underwent an operative procedure under ESM-Ketamine at Sagam Community Hospital in Luanda, Kenya were enrolled. Participants underwent two semi-structured interviews that explored the patient's experience with ESM-Ketamine both after the operative procedure and four to six weeks after surgery. RESULTS Forty-seven participants completed the first interview and 37 (78.7%) the second interview. Thirty-seven (78.7%) cases were procedural sedations and ten were (21.3%) emergency surgeries. Intraoperative awareness occurred in nine (24.3%) participants who underwent procedural sedation and two (20%) who underwent emergency surgery. Twenty-six (55.3%) participants reported dreams during the procedure. Thirty-two (86.5%) participants considered their experience positive, and 35 (95%) would recommend a procedure supported by ketamine to a friend. DISCUSSION Most patients whose painful procedures and emergency operations were supported by the ESM-Ketamine package when no anaesthetist was available reported favourable experiences.
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Affiliation(s)
- Sarah Villegas
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Sebastian Suarez
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Owuor
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Gabriella M. Wuyke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Brett D. Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Javan Imbamba
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Debora Rogo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Khama Rogo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Thomas F. Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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6
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Kibwana S, Yigzaw M, Molla Y, van Roosmalen J, Stekelenburg J. Job satisfaction among anesthetists in Ethiopia-a national cross-sectional study. Int J Health Plann Manage 2018; 33:e960-e970. [PMID: 30033611 DOI: 10.1002/hpm.2573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia has substantially increased production of associate clinician anesthetists. This study aimed to determine the level of and factors that predict job satisfaction among a national sample of anesthetists. METHODS A cross-sectional study conducted in 2014 sampled 252 anesthetists. Respondents rated 37 items related to job satisfaction and working and living conditions using a Likert scale, which ranged from 1 (strongly disagree) to 5 (strongly agree). Univariate and multivariable logistic regressions were used to determine factors associated with the main outcome variable, level of job satisfaction. Adjusted odds ratios and 95% confidence intervals were calculated to show the magnitude of associations. RESULTS Less than half (n = 107, 42.5%) of anesthetists were satisfied with their job. Work environment (aOR = 1.87, 95% CI = 1.06, 3.31) and more than 10 years of experience working in the public health system (aOR = 4.96, 95% CI = 1.11, 22.13) were predictors of job satisfaction in the multivariable model. CONCLUSION Ethiopian anesthetists have low levels of job satisfaction, with work environment and years of experience being factors that predict their satisfaction positively. Motivation and retention of this cadre will require emphasis on creating a safe and conducive work environment, and interventions designed to motivate junior anesthetists.
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Affiliation(s)
| | | | | | | | - Jelle Stekelenburg
- Department of Obstetrics & Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands.,Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
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7
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Suarez S, Burke TF, Yusufali T, Makin J, Sessler DI. The role of ketamine in addressing the anesthesia gap in low-resource settings. J Clin Anesth 2018; 49:42-43. [PMID: 29885624 DOI: 10.1016/j.jclinane.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sebastian Suarez
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya; Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Taha Yusufali
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya; College of Surgery for East, Central, and Southern Africa, Arusha, Tanzania
| | - Jennifer Makin
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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8
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Burke TF, Suarez S, Sessler DI, Senay A, Yusufali T, Masaki C, Guha M, Rogo D, Jani P, Nelson BD, Rogo K. Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures. World J Surg 2017; 41:2990-2997. [DOI: 10.1007/s00268-017-4312-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Potisek MG, Hatch DM, Atito-Narh E, Agudogo J, Olufolabi AJ, Rieker M, Muir HA, Owen MD. Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates. Front Public Health 2017; 5:78. [PMID: 28451585 PMCID: PMC5390021 DOI: 10.3389/fpubh.2017.00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/25/2022] Open
Abstract
Ghana, like other countries in sub-Saharan African, has limited access to surgery. One contributing factor is the inadequate number of anesthesia providers. To address this need, Kybele, Inc., a US-based non-governmental organization, partnered with the Ghana Health Service to establish the third nurse anesthesia training school (NATS) in Ghana. The school, based at Ridge Regional Hospital (RRH) in Accra, opened in October 2009. This paper describes the evolution of the training program and presents the curriculum. Second, the results of a voluntary survey conducted among the first four classes of graduates (2011–2014) are presented to determine their perceived strengths and gaps in training and to identify employment locations and equipment availability. Seventy-five of 93 graduates (81%) responded to the survey. The graduates reported working in 39 hospitals across 7 of the 10 regions in Ghana. Six providers (8%) worked alone and 16 (21%) were one of only two providers. Fifty-three providers (71%) had no physician anesthesiologist at their facility. Most providers had access to basic anesthesia equipment; however, there was limited access to emergency airway equipment. While most graduates felt that their training had prepared them for their current positions, 21% reported experiencing a patient death during anesthesia. The NATS at RRH has been sustained and most of the graduates are working in Ghana, filling an important void. Quality improvement and continuing education must be emphasized in an effort to reduce surgical morbidity and mortality in Ghana.
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Affiliation(s)
- Melissa G Potisek
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David M Hatch
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Evans Atito-Narh
- Department of Anesthesiology, Ghana Health Service, Ridge Regional Hospital, Accra, Ghana
| | - Jerry Agudogo
- Department of Anesthesiology, Ghana Health Service, Ridge Regional Hospital, Accra, Ghana
| | - Adeyemi J Olufolabi
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Michael Rieker
- School of Nurse Anesthesia, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Holly A Muir
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Medge D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound 2017; 5:8. [PMID: 28194274 PMCID: PMC5299783 DOI: 10.1186/s40349-017-0088-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. The aim of this study was to explore if a sedation regimen with low-dose propofol and ketamine performed by trained non-medical sedation practitioners could result in relief of discomfort for the patient and in adequate working conditions for MR-HIFU treatment for uterine fibroids. Methods In this study, conducted from August 2013 until November 2014, 20 patients were subjected to MR-HIFU treatment of uterine fibroids. Patients were deeply sedated using intravenous propofol and esketamine according to a standardised hospital protocol to allow synchronisation of the breathing pattern to the MR-HIFU. The quality of sedation for MR-HIFU and complications were recorded and analysed. The side effects of the sedation technique, the propofol and esketamine consumption rate, the duration of recovery, and patient satisfaction after 24 h were examined. Results A total of 20 female patients (mean age 42.4 [range 32–53] years) were enrolled. Mean propofol/esketamine dose was 1309 mg/39.5 mg (range 692–1970 mg/ 23.6–87.9 mg). Mean procedure time was 269 min (range 140–295 min). Application of the sedation protocol resulted in a regular breathing pattern, which could be synchronised with the MR-HIFU procedures without delay. The required treatment was completed in all cases. There were no major adverse events. Hypoxemia (oxygen desaturation <92%) and hallucinations were not observed. Conclusions The use of a specific combination of IV propofol and esketamine for procedural sedation and analgesia reduced the discomfort and pain during MR-guided HIFU treatments of uterine fibroids. The resulting regular breathing pattern allowed for easy synchronisation of the MR-HIFU procedure. Based on our results, esketamine and propofol sedation performed by trained non-medical sedation practitioners is feasible and safe, has a low risk of major adverse events, and has a short recovery time, avoiding a session of general anaesthesia. Electronic supplementary material The online version of this article (doi:10.1186/s40349-017-0088-9) contains supplementary material, which is available to authorized users.
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11
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Burke TF, Nelson BD, Kandler T, Altawil Z, Rogo K, Imbamba J, Odenyo S, Pinder L, Lozo S, Guha M, Eckardt MJ. Evaluation of a ketamine-based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available. Int J Gynaecol Obstet 2016; 135:295-298. [PMID: 27614787 DOI: 10.1016/j.ijgo.2016.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/25/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022]
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 5days 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 <30s) 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.
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Affiliation(s)
- Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Taylor Kandler
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Zaid Altawil
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Khama Rogo
- Sagam Community Hospital, Luanda, Kenya; Kenya Obstetrics and Gynaecological Society, Nairobi, Kenya
| | | | | | - Leeya Pinder
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya
| | - Svjetlana Lozo
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya
| | - Moytrayee Guha
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Melody J Eckardt
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Schwartz KR, Fredricks K, Al Tawil Z, Kandler T, Odenyo SA, Imbamba J, Nelson BD, Burke TF. An innovative safe anesthesia and analgesia package for emergency pediatric procedures and surgeries when no anesthetist is available. Int J Emerg Med 2016; 9:16. [PMID: 27286891 PMCID: PMC4901210 DOI: 10.1186/s12245-016-0113-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background Adequate pain control through sedation and anesthesia for emergency procedures is a crucial aspect of pediatric emergency care. Resources for administering such anesthesia are extremely limited in many low-income settings. Methods Non-anesthetist providers in Western Kenya were trained in the use of a ketamine-based sedation and anesthesia package for non-anesthetists, Every Second Matters for Mothers and Babies-Ketamine™ (ESM-Ketamine). Data on use and safety of this package for emergent and urgent pediatric procedures was collected. Providers were surveyed as to what they would have done for similar procedures if the ESM-Ketamine package were unavailable. Results Ninety procedures were completed for 77 pediatric patients utilizing the ESM-Ketamine package. Of these, 29 (32.2 %) cases were orthopedic reductions, 19 (21.1 %) were incision and drainage, and 19 (21.1 %) were debridement and irrigation of burns. Remaining cases included cesarean section, repair of perineal tear, foreign body removal, arthrocentesis, laceration repair, exploratory laparotomy, excision of mass, paracentesis, and circumcision. There were no serious adverse events in any of the cases, 17 % experienced minor adverse events including hypersalivation, hallucinations, or brief, self-resolving, oxygen desaturations. Providers were surveyed for 80 of the 90 cases as to what they would have done in the absence of the ESM-Ketamine package: in 26 cases (32.5 %), they reported they would proceed with the procedure without any anesthesia or analgesia; in 15 (18.75 %), they reported they would significantly delay the procedure while waiting for an anesthetist; in 13 (16.25 %), they reported they would attempt referral to another facility; and in 26 (32.5 %), they reported they would try using an alternate form of analgesia, primarily acetaminophen, ibuprofen, diclofenac, and/or diazepam. All surveyed providers reported they would use the ESM-Ketamine package again in similar cases. Conclusions The ESM-Ketamine package, through the use of a simplified protocol and checklist, allows for safe analgesia and anesthesia in children by non-anesthetists in a resource-limited setting for selected emergent and urgent procedures. This package addresses a significant gap in the availability of anesthesia services in low-income settings that would otherwise result in significant delays to procedures or proceeding with painful procedures with inadequate analgesia.
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Affiliation(s)
- Kevin R Schwartz
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
| | - Karla Fredricks
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA
| | - Zaid Al Tawil
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA
| | - Taylor Kandler
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA
| | - Stella A Odenyo
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Javan Imbamba
- African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya
| | - Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
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