Villegas Sarah, Suarez Sebastian, Owuor Joseph, Wuyke Gabriella M, Nelson Brett D, Imbamba Javan, Rogo Debora, Rogo Khama, Burke Thomas F
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
African Institute for Health Transformation, Sagam Community Hospital, Luanda, Kenya.
Afr J Emerg Med. 2019;9(Suppl):S56-S60. doi: 10.1016/j.afjem.2018.07.003. Epub 2018 Jul 26.
Five of the 7.2 billion people on earth have limited access to emergency and essential surgical procedures. The lack of safe, affordable and timely anaesthesia services are primary barriers to universal surgical coverage. The objective of this study was to assess intraoperative awareness when the 'Every Second Matters for Emergency and Essential Surgery - Ketamine' (ESM-Ketamine) package was used to support emergency and essential surgeries and painful procedures in rural Kenya when no anaesthetist was available.
Forty-seven consecutive adult patients that underwent an operative procedure under ESM-Ketamine at Sagam Community Hospital in Luanda, Kenya were enrolled. Participants underwent two semi-structured interviews that explored the patient's experience with ESM-Ketamine both after the operative procedure and four to six weeks after surgery.
Forty-seven participants completed the first interview and 37 (78.7%) the second interview. Thirty-seven (78.7%) cases were procedural sedations and ten were (21.3%) emergency surgeries. Intraoperative awareness occurred in nine (24.3%) participants who underwent procedural sedation and two (20%) who underwent emergency surgery. Twenty-six (55.3%) participants reported dreams during the procedure. Thirty-two (86.5%) participants considered their experience positive, and 35 (95%) would recommend a procedure supported by ketamine to a friend.
Most patients whose painful procedures and emergency operations were supported by the ESM-Ketamine package when no anaesthetist was available reported favourable experiences.
地球上72亿人口中有5亿人获得紧急和基本外科手术的机会有限。缺乏安全、可负担且及时的麻醉服务是实现普遍外科覆盖的主要障碍。本研究的目的是评估在肯尼亚农村地区没有麻醉师的情况下，使用“紧急和基本手术中的每一秒都至关重要——氯胺酮”（ESM-氯胺酮）套餐来支持紧急和基本手术及疼痛治疗时的术中知晓情况。
连续纳入了47例在肯尼亚罗安达的萨加姆社区医院接受ESM-氯胺酮治疗下进行手术的成年患者。参与者接受了两次半结构化访谈，分别在手术后以及术后四至六周探讨患者使用ESM-氯胺酮的体验。
47名参与者完成了第一次访谈，37名（78.7%）完成了第二次访谈。37例（78.7%）为程序性镇静，10例（21.3%）为急诊手术。接受程序性镇静的9名（24.3%）参与者和接受急诊手术的2名（20%）参与者发生了术中知晓。26名（55.3%）参与者报告在手术过程中做梦。32名（86.5%）参与者认为他们的体验是积极的，35名（95%）会向朋友推荐氯胺酮支持的手术。
在没有麻醉师的情况下，大多数接受ESM-氯胺酮套餐支持进行疼痛治疗和急诊手术的患者报告了良好的体验。
