Osifo David O, Emeagui Kennedy N, Aghahowa Sylvester E
Department of Surgery, Pediatric Surgery Unit, University of Benin, Teaching Hospital, Benin City, Nigeria.
Saudi Med J. 2008 Jan;29(1):60-4.
To study the safety and benefits of parenteral ketamine and lignocaine infiltration among pediatric surgical patients with co-morbidities that would preclude the use of general anesthesia requiring endotracheal intubation/face mask in a developing country.
This prospective study was undertaken at the Leadeks Medical Centre, Benin City Edo State, Nigeria between January 2002 and December 2006. Patients requiring surgery were safely operated even in the presence of co-morbidity.
A total of 416 children were recruited and they were aged 6 days to 16 years (mean 12 -/+ 2.04 years) with a male/female ratio of 1:1.1. Appendectomy (33.2%), herniotomy (20.2%) and suturing of laceration (15.9%) were the most common indications for surgery. Anemia, upper respiratory tract infections, malnutrition, malaria fever, typhoid fever, and retroviral infections were co-morbidities. Ambulatory surgery was carried out in 48.6% patients. Overall, only 23.3% experienced postoperative pain, which was statistically significant in those that had laparotomy and appendectomy (p<0.0001), and analgesics such as paracetamol were enough to relieve the pain. Complications recorded such as postoperative vomiting, emergence reaction, wound infection, post operative fever, and apnea occurring after ketamine injections were tolerated and no mortality was recorded.
The satisfactory anesthesia and analgesia recorded with this combination, and the low complications observed in the presence of co-morbidity showed that these agents have much to offer in a developing country.
研究在发展中国家，对于患有合并症而无法使用需要气管插管/面罩的全身麻醉的小儿外科患者，静脉注射氯胺酮和利多卡因进行浸润麻醉的安全性和益处。
这项前瞻性研究于2002年1月至2006年12月在尼日利亚江户州贝宁城的利德克斯医疗中心进行。即使存在合并症，需要手术的患者也能安全地接受手术。
共招募了416名儿童，年龄在6天至16岁之间（平均12±2.04岁），男女比例为1:1.1。阑尾切除术（33.2%）、疝气修补术（20.2%）和伤口缝合术（15.9%）是最常见的手术指征。合并症包括贫血、上呼吸道感染、营养不良、疟疾发热、伤寒热和逆转录病毒感染。48.6%的患者接受了门诊手术。总体而言，只有23.3%的患者术后疼痛，在接受剖腹手术和阑尾切除术的患者中具有统计学意义（p<0.0001），对乙酰氨基酚等镇痛药足以缓解疼痛。记录的并发症如术后呕吐、苏醒反应、伤口感染、术后发热和氯胺酮注射后出现的呼吸暂停均能耐受，未记录到死亡病例。
这种联合用药记录到了令人满意的麻醉和镇痛效果，并且在存在合并症的情况下观察到的低并发症表明，这些药物在发展中国家有很大的应用价值。
