Evaluation of a ketamine-based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available.
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.


CONCLUSIONS
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.
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. Electronic address: tfburke@partners.org.
Thomas F
TF
Burke
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Brett D
BD
Nelson
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Taylor
T
Kandler
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Zaid
Z
Altawil
Sagam Community Hospital, Luanda, Kenya; Kenya Obstetrics and Gynaecological Society, Nairobi, Kenya.
Khama
K
Rogo
Sagam Community Hospital, Luanda, Kenya.
Javan
J
Imbamba
Sagam Community Hospital, Luanda, Kenya.
Stella
S
Odenyo
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.
Leeya
L
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
S
Lozo
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Moytrayee
M
Guha
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Melody J
MJ
Eckardt
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D007630:Kenya; D007649:Ketamine / Q000008:administration & dosage*; D007813:Laparotomy; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
D000700:Analgesics; D007649:Ketamine
Anesthesia; Cesarean delivery; Emergency surgery; Ketamine; Laparotomy; Low-resource setting; Maternal health; Maternal mortality; Task shifting