Feasibility of a Ketamine Anesthesia Package in Support of Obstetric and Gynecologic Procedures in Kenya When No Anesthetist is Available

Charles O. Masaki, Jennifer Makin, Sebastian Suarez, Gabriella Wuyke, Ayla N. Senay, Daniela Suarez-Rebling, Javan Imbamba, Jackton Juma, Moytrayee Guha, Thomas F. Burke

Abstract

The objective was to assess the feasibility and safety of the ‗Every Second Matters for Emergency and Essential Surgery – Ketamine‘ (ESM-Ketamine) package in support of obstetric and gynecologic emergency and essential surgery when no anesthetist is available. A consecutive case series was conducted in twelve hospitals across five severely resource-limited counties in Kenya. 530 women underwent obstetric or gynecological operative procedures supported by non-anesthetist clinicians using the ESM-Ketamine package between November 1, 2013 and September 30, 2017. Main outcomes included reasons for ESM-Ketamine activations and ketamine-related adverse events. There were two (0.4%) prolonged (>30 seconds) oxygen desaturations below 92%. Brief oxygen desaturations (<30 seconds) below 92% occurred in 15 (2.8%) cases and 113 (21.3%) were administered diazepam to treat hallucinations or agitation. There were no ketamine-related deaths or injuries. The ESM-Ketamine package appears feasible and safe for use in support of obstetric and gynecologic surgeries when no anesthetist is available. (Afr J Reprod Health 2019; 23[1]: 37-45).

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