Green S M, Clem K J, Rothrock S G
Loma Linda University School of Medicine, Department of Emergency Medicine, CA 92354, USA.
Acad Emerg Med. 1996 Jun;3(6):598-604.
To evaluate the safety profile of ketamine when used to facilitate surgical procedures in the less controlled setting of developing world, rural hospitals.
A survey addressing clinical experience with ketamine in the developing world was administered to a convenience sample of missionary physicians. Descriptive statistics are reported.
Of the 172 surveyed physicians, 122 (71%) responded; 55 reported experience with ketamine. These physicians estimated a total of 12,844 administrations. The format of one procedural physician and a second trained anesthesiologist/anesthetist was unavailable in the practice of 59% of the responding physicians, and 34% routinely performed procedures while simultaneously supervising ketamine administration and monitoring its clinical effect. Pulse oximetry was used "often" or "always" by only 10% of the physicians. Cardiac monitoring and intermittent vital signs were used in only 19% and 45%, respectively. One unexplained pediatric death occurred during an unmonitored, unobserved ward recovery. An adult suffered cardiac arrest after a failed intubation attempt. Seventeen other complications possibly related to ketamine were apnea (n = 10), laryngospasm (n = 6), and aspiration (n = 1), all of which were transient and without sequelae. Physicians believed that recovery hallucinations and agitation were frequent in adults and unusual in children.
Death and other serious complications were rare in this survey reporting > 12,000 estimated ketamine administrations in the developing world. Although the limitations of survey data are recognized, the margin of safety with ketamine appears to be high, even when administered by non-anesthesiologists in settings lacking basic mechanical monitoring. These findings have important implications for the use of ketamine outside the controlled operating room environment in developed countries.
评估在发展中国家农村医院这种控制条件较差的环境中，氯胺酮用于辅助外科手术时的安全性。
对方便抽样的传教士医生进行了一项关于氯胺酮在发展中国家临床应用经验的调查。报告了描述性统计数据。
在172名接受调查的医生中，122名（71%）做出了回应；55名报告有氯胺酮使用经验。这些医生估计总共进行了12844次给药。59%做出回应的医生在实际操作中没有配备一名手术医生和一名经过培训的麻醉医生/麻醉师，34%的医生在常规进行手术的同时还要监督氯胺酮给药并监测其临床效果。只有10%的医生“经常”或“总是”使用脉搏血氧饱和度仪。分别只有19%和45%的医生使用心脏监测和间歇性生命体征监测。在未受监测、无人观察的病房恢复期间发生了1例不明原因的儿科死亡。1例成年人在插管尝试失败后发生心脏骤停。另外17例可能与氯胺酮相关的并发症包括呼吸暂停（n = 10）、喉痉挛（n = 6）和误吸（n = 1），所有这些均为短暂性且无后遗症。医生们认为恢复过程中的幻觉和躁动在成年人中很常见，在儿童中不常见。
在本次调查中，报告在发展中国家估计有超过12000次氯胺酮给药，死亡和其他严重并发症很少见。尽管认识到调查数据存在局限性，但即使在缺乏基本机械监测的环境中由非麻醉医生给药，氯胺酮的安全系数似乎也很高。这些发现对于在发达国家受控手术室环境之外使用氯胺酮具有重要意义。
