在没有麻醉师的情况下用于紧急剖宫产的氯胺酮包：对 401 例连续手术的分析。

A ketamine package for use in emergency cesarean delivery when no anesthetist is available: An analysis of 401 consecutive operations.

机构信息

Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Int J Gynaecol Obstet. 2022 Aug;158(2):377-384. doi: 10.1002/ijgo.13965. Epub 2021 Oct 28.

DOI:10.1002/ijgo.13965

PMID:34606101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9545139/

Abstract

OBJECTIVE

To evaluate the safety and effectiveness of a ketamine-based anesthesia package to support emergency cesarean section when no anesthetist is available.

METHODS

A prospective case-series was conducted between December 11, 2013 and September 30, 2021 across nine sub-county hospitals in Kenya. Non-anesthetist healthcare providers undertook an evidence-based five-day training course. A structured instrument was used to collect preoperative, intraoperative, and postoperative data, and patients were contacted 6 months following the surgery to collect outcomes. The primary outcome measures were maternal and newborn survival and the ability of the ketamine package (ESM-Ketamine) to safely support cesarean deliveries.

RESULTS

A total of 401 emergency cesarean sections were performed using ketamine, administered by 54 non-anesthetist providers. All mothers survived to discharge. Brief oxygen desaturations were recorded among 33 (8.2%) mothers, and agitation and hallucinations occurred among 13 (3.2%). There were no maternal serious adverse events. At 6-month follow-up, 94.2% of mothers who could be reached reported no complaints. Additionally, 402 (92.4%) of the 435 operative births survived to discharge.

CONCLUSION

The ESM-Ketamine package can be used by trained non-anesthetist providers to support emergency cesarean sections when no anesthetist is available. Ketamine has significant potential to increase access to emergency cesarean deliveries in resource-limited settings.

摘要

目的

评估一种基于氯胺酮的麻醉方案在没有麻醉师的情况下用于紧急剖宫产的安全性和有效性。

方法

2013 年 12 月 11 日至 2021 年 9 月 30 日，在肯尼亚的 9 家次级县医院进行了一项前瞻性病例系列研究。非麻醉医护人员接受了基于证据的为期五天的培训课程。使用结构化仪器收集术前、术中、术后数据，并在手术后 6 个月联系患者收集结果。主要结局指标为母婴存活率和氯胺酮方案（ESM-氯胺酮）安全支持剖宫产的能力。

结果

共有 401 例紧急剖宫产术使用氯胺酮进行，由 54 名非麻醉师提供者实施。所有母亲均存活至出院。33 名（8.2%）母亲记录到短暂的氧饱和度下降，13 名（3.2%）母亲出现激动和幻觉。无母亲严重不良事件。在 6 个月的随访中，能够联系到的 94.2%的母亲报告没有任何抱怨。此外，435 例手术分娩中有 402 例（92.4%）存活至出院。