title: A Safe-Anesthesia Innovation for Emergency and Life-Improving Surgeries When no Anesthetist is Available: A Descriptive Review of 193 Consecutive Surgeries.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 104, Boston, MA, 02114, USA, tfburke@partners.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
authors.forename: Yogeeta
authors.initials: Y
authors.lastname: Manglani
authors.forename: Zaid
authors.initials: Z
authors.lastname: Altawil
authors.forename: Alexandra
authors.initials: A
authors.lastname: Dickson
authors.forename: Rachel
authors.initials: R
authors.lastname: Clark
authors.forename: Stephen
authors.initials: S
authors.lastname: Okelo
authors.forename: Roy
authors.initials: R
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D000776:Anesthesiology / Q000193:education; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004630:Emergencies; D006212:Hallucinations / Q000139:chemically induced; D006295:Health Resources; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D000078329:Workforce; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine; D010100:Oxygen