Burke Thomas F, Suarez Sebastian, Senay Ayla, Masaki Charles, Rogo Khama, Sessler Daniel I, Yusufali Taha, Rogo Debora, Guha Moytrayee, Jani Pankaj, Nelson Brett D
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.
Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
World J Surg. 2017 Dec;41(12):2990-2997. doi: 10.1007/s00268-017-4312-0.
Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available.
From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists.
Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (<30 s) oxygen desaturations occurred in 39 patients (3%), and prolonged (>30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations.
The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.
在低收入和中等收入国家，无法获得急诊和基本外科手术的情况普遍存在。麻醉服务稀缺加剧了这一未得到满足的需求。本研究的目的是评估在没有麻醉医生的情况下，用于急诊和基本手术的“紧急与基本手术——氯胺酮每秒都重要”（ESM-氯胺酮）方案的安全性和可行性。
2013年11月至2017年9月，在肯尼亚各地15家选定的医疗机构中，当没有麻醉医生时，ESM-氯胺酮方案被用于需要急诊或改善生活手术的患者。采用混合方法评估ESM-氯胺酮方案的安全性和可行性，包括需求、可接受性和实用性。主要结局是与氯胺酮相关的不良事件。关键信息提供者访谈收集了提供者、医院管理人员和外科医生/手术医生的看法。
非麻醉医生的中级医疗人员在15个研究机构中对1216例手术使用了ESM-氯胺酮。氯胺酮的中位剂量为2.1mg/kg。39例患者（3%）出现短暂（<30秒）的氧饱和度下降，7例患者（0.6%）出现持续（>30秒）的氧饱和度下降。有157例（13%）报告的幻觉和躁动病例，用安定进行了治疗。所有患者均顺利康复，未报告与氯胺酮相关的死亡。27次关键信息提供者访谈显示对该方案有强烈支持，有四个主要主题：财务考虑因素、服务提供、对工作人员的影响和扩大规模的考虑因素。
ESM-氯胺酮方案似乎是安全可行的，并且在没有麻醉医生的情况下，能够扩大肯尼亚农村地区急诊和基本外科手术的可及性。
