Key result
The ESM-Ketamine package safely supported 193 surgeries without major adverse events, though brief desaturation occurred in 8.6% and hallucinations in 12.1% of patients.
Why the study?
Does the ESM-Ketamine package safely support emergency and life-improving surgeries when administered by non-anesthetist clinicians in resource-limited settings?
Observational (n=193)
Yes
Does the ESM-Ketamine package safely support emergency and life-improving surgeries when administered by non-anesthetist clinicians in resource-limited settings?
The ESM-Ketamine package can safely support emergency and life-improving surgeries in resource-limited settings when administered by trained non-anesthetist clinicians.
May support non-anesthetist use in resource-limited settings; hypothesis-generating, requires randomized confirmation before practice change.
BACKGROUND: The worldwide human resource gap in anesthesia services often presents a barrier to accessing life-saving and life-improving surgeries. This paper assessed the impact of a ketamine anesthesia package, Every Second Matters-Ketamine (ESM-Ketamine)™, for use in emergency and life-improving surgeries by non-anesthetist clinicians in a resource-limited setting when no anesthetist was available. METHODS: We analyzed prospectively collected data from 193 surgeries constituting a pilot implementation of the ESM-Ketamine package, among three sub-district hospitals in Western Kenya. The study population comprises patients who required emergency or life-improving surgery when no anesthetist was available. Non-anesthetist clinicians in three sub-district hospitals underwent a 5-day training course in ESM-Ketamine complemented by checklists and an ESM-Ketamine Kit. Data were collected prospectively every time the ESM-Ketamine pathway was invoked. The training cases, although primarily tubal ligations, were included. The primary outcome measures centered on capturing the ability to safely support emergency and life-improving surgeries, when no anesthetist was available, through invoking the ESM-Ketamine pathway. The registry was critically examined using standard descriptive and frequency analysis. RESULTS: 193 surgical procedures were supported using the ESM-Ketamine package by five ESM-Ketamine trained providers. Brief (<30 s) patient desaturation below 92% and hallucinations occurred in 16 out of 186 (8.6%) and 23 out of 190 patients (12.1%), respectively. There were no reported major adverse events such as death, prolonged desaturations (over 30 s), or injury resulting from ketamine use. CONCLUSION: This study provides promising initial evidence that the ESM-Ketamine package can support emergency and life-improving surgeries in resource-limited settings when no anesthetist is available.
No takes yet. Share an insight, caveat, or question.
Burke et al. (2015) conducted an observational in Patients requiring emergency or life-improving surgery when no anesthetist is available (n=193). Every Second Matters-Ketamine (ESM-Ketamine) package was evaluated on Ability to safely support emergency and life-improving surgeries (assessed via adverse events such as desaturation, hallucinations, and major adverse events). The ESM-Ketamine package safely supported 193 surgeries without major adverse events, though brief desaturation occurred in 8.6% and hallucinations in 12.1% of patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: