Masaki Charles O, Makin Jennifer, Suarez Sebastian, Wuyke Gabriella, Senay Ayla N, Suarez-Rebling Daniela, Imbamba Javan, Juma Jackton, Guha Moytrayee, Burke Thomas F
Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Afr J Reprod Health. 2019 Mar;23(1):37-45. doi: 10.29063/ajrh2019/v23i1.4.
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.
目的是评估在没有麻醉医生的情况下，“紧急和基本外科手术中的氯胺酮——分秒必争”（ESM-氯胺酮）方案用于支持妇产科紧急和基本外科手术的可行性和安全性。在肯尼亚五个资源严重受限的县的12家医院开展了一项连续病例系列研究。2013年11月1日至2017年9月30日期间，530名妇女在非麻醉医生临床医生使用ESM-氯胺酮方案的支持下接受了妇产科手术操作。主要结局包括启动ESM-氯胺酮的原因以及与氯胺酮相关的不良事件。有两例（0.4%）氧饱和度低于92%的情况持续时间延长（>30秒）。15例（2.8%）出现氧饱和度低于92%的短暂情况（<30秒），113例（21.3%）使用地西泮治疗幻觉或躁动。没有与氯胺酮相关的死亡或损伤。ESM-氯胺酮方案在没有麻醉医生的情况下用于支持妇产科手术似乎是可行和安全的。
