Key result
Use of the ESM-Ketamine package for procedures without an anaesthetist resulted in intraoperative awareness in 11 of 47 patients, though 86.5% of followed-up patients reported a positive experience.
Why the study?
Does the ESM-Ketamine package provide acceptable patient experience and intraoperative awareness rates for emergency surgeries in settings without an anesthetist?
Observational (n=47)
No
Does the ESM-Ketamine package provide acceptable patient experience and intraoperative awareness rates for emergency surgeries in settings without an anesthetist?
A ketamine-based anesthesia package administered by non-anesthetists in rural Kenya resulted in high rates of intraoperative awareness but overall positive patient experiences.
Answers are grounded in this paper and cite their sources.
Awareness risk with ESM-Ketamine without an anaesthetist warrants caution; this Level 5 finding leaves open its safety and role pending prospective trials.
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. DISCUSSION: Most patients whose painful procedures and emergency operations were supported by the ESM-Ketamine package when no anaesthetist was available reported favourable experiences.
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Villegas et al. (2018) conducted an observational in Emergency and essential surgeries and painful procedures (n=47). ESM-Ketamine package was evaluated on Intraoperative awareness and patient experience. Use of the ESM-Ketamine package for procedures without an anaesthetist resulted in intraoperative awareness in 11 of 47 patients, though 86.5% of followed-up patients reported a positive experience.
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