Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands.
Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
BMC Health Serv Res. 2024 May 7;24(1):598. doi: 10.1186/s12913-024-11040-w.
Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled.
This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach.
The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants.
Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.
在撒哈拉以南非洲地区，人们获得麻醉和手术护理的机会有限。在该地区，氯胺酮是提供麻醉护理的关键药物。然而，国际社会将氯胺酮作为管制物质进行管控的努力可能会显著影响其可及性。因此，这项研究旨在评估氯胺酮对撒哈拉以南非洲地区麻醉和手术护理的重要性，并评估如果将其列入附表，对获取氯胺酮的潜在影响。
这是一项混合方法研究，包括在卢旺达的医院层面进行的横断面调查以及对撒哈拉以南非洲地区麻醉护理专家的关键知情人访谈。从卢旺达的 54 家医院收集了四种麻醉剂的供应情况数据。对 10 名关键知情人进行了半结构式访谈，收集了关于氯胺酮重要性、国际上管制氯胺酮的潜在影响以及对氯胺酮滥用的看法的信息。访谈内容逐字记录，并采用主题分析方法进行分析。
在卢旺达进行的调查发现，氯胺酮和异丙酚的供应情况相当，约为 80%，而硫喷妥钠和吸入性麻醉剂仅在大约一半的医院供应。确定了阻碍获得麻醉护理机会的重大障碍，包括政府普遍对该专业关注度不足、麻醉师短缺和受过培训的麻醉师移民以及药品和设备匮乏。由于这些障碍，氯胺酮被描述为提供麻醉护理的关键药物。知情人认为氯胺酮的滥用不是问题。
氯胺酮是撒哈拉以南非洲地区提供麻醉护理的关键药物，如果将其列入附表，将对其用于麻醉护理的供应产生重大负面影响。
