Evaluation of a ketamine‐based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available

Burke, Thomas F.; Nelson, Brett D.; Kandler, Taylor; Altawil, Zaid; Rogo, Khama; Imbamba, Javan; Odenyo, Stella; Pinder, Leeya; Lozo, Svjetlana; Guha, Moytrayee; Eckardt, Melody J.

doi:10.1016/j.ijgo.2016.06.024

Cited by 4 publications

(10 citation statements)

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“…Evaluation of the ESM-Ketamine programme in 2059 Kenyan patients identified only occasional mild adverse events associated with ketamine such as hallucinations and salivation, and no major adverse events. 12 We; therefore, assumed that ESM-Ketamine does not cause major morbidities and did not include the minor consequences of the occasional mild and time-limited adverse events since they pale in comparison to the consequences of not providing emergency caesarean delivery.…”

Section: Methodsmentioning

confidence: 99%

“…The ESM-Ketamine pilot programme in Kenya has proven remarkably safe, with positive patient experiences, no deaths or major adverse events attributed to ketamine in more than 2000 emergency and essential surgeries including about 450 caesarean deliveries across 17 hospitals. 12 13 However, there are distinct training, implementation and running costs associated with the ESM-Ketamine programme. In this analysis, we model the potential health impact and cost-effectiveness of scaling up the ESM-Ketamine programme for emergency caesarean sections throughout Kenya as compared with the status quo.…”

Section: Introductionmentioning

confidence: 99%

“…The programme includes an intensive hands-on 5-day training, ESM-Ketamine kits, wallcharts, checklists and regular supervisory visits for quality assurance (QA). The ESM-Ketamine pilot programme in Kenya has proven remarkably safe, with positive patient experiences, no deaths or major adverse events attributed to ketamine in more than 2000 emergency and essential surgeries including about 450 caesarean deliveries across 17 hospitals 12 13. However, there are distinct training, implementation and running costs associated with the ESM-Ketamine programme.…”

Section: Introductionmentioning

confidence: 99%

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Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis

et al. 2022

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ObjectivesLack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries.SettingHospitals in Kenyan counties with low rates of caesarean delivery.ParticipantsPatients needing emergency caesarean delivery in settings without availability of standard anaesthesia service.InterventionsSimulated scales up of the ESM-Ketamine programme over 5 years (2020–24) was compared with status quo.Outcome measuresCost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo.ResultsOver 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario—a very good value for Kenya at less than 20% of per capita GDP per life-year gained.ConclusionIn areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis

et al. 2022

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“…These care providers are projected to significantly increase the number of caesarean sections performed each year [10]. Another identified publication reported a similar training program for non-physician surgeons in Ethiopia, resulting in an increase in local surgical capacity, demonstrated by an increase in caesarean sections and laparotomies performed [11].Similar programs in Liberia and Kenya trained non-physician healthcare workers in surgical and anesthesia skills, resulting in increased local capacity for caesarean sections and laparotomies [12,13] Thus, in all four included studies, task-sharing with nonphysician surgeons was deemed to be an effective method of increasing timely access to care in LMIC.…”

Section: Education: Improved Learning Resources and Taskshiftingmentioning

confidence: 99%

Evaluation of Interventions Addressing Timely Access to Surgical Care in Low‐Income and Low‐Middle‐Income Countries as Outlined by the LANCET Commission 2030 Global Surgery Goals: A Systematic Review

et al. 2021

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Background In 2015, the Lancet Commission on Global Surgery published six global surgery goals, one of which was to provide 80% of the world's population with timely access to the Bellwether Surgical procedures. Little is known about the prevalence or efficacy of subsequent interventions implemented in under‐resourced countries to increase timely access to Bellwether surgical procedures. Methods A systematic review of articles and grey literature published in MEDLINE, Embase, Cochrane, CINAHL, and Web of Science databases was conducted. Two independent reviewers evaluated 1923 captured abstracts using explicit inclusion and exclusion criteria. Following a thematic analysis, two reviewers conducted data extraction on the eleven manuscripts included in the final review. Results The studied innovations, sparse in number, centred on improved educational resources, the development of orthopaedic devices, and models for assessing surgical access disparity. Eight papers were centred around timely access to caesarean sections, three around open fracture reduction, and three around laparotomy; all focused on adult populations. Five papers addressed innovations in West Africa, two in East Africa, two in South Asia, and one in Southeast Asia. Common outcome metrics were not used to assess improvements to timely surgical access. Conclusions Few published interventions have been implemented since the publication of the 2015 Lancet Commission on Global Surgery goals that have or will longitudinally increase the availability of timely surgical access in Low and Middle‐Income Countries (LMIC). Tangible outcome measures in existing literature are lacking. An up‐scaling and wider adoption of successful strategies is necessary and possible.

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“…To date, ESM-Ketamine has been used in more than 1500 emergency operations and painful procedures in rural Kenya, with no cases of ketamine-related deaths or disability. The ESM-Ketamine package has significantly increased access to anaesthesia services and has provided safe and effective pain control during surgery when no anaesthetist was available [3] , [6] , [10] , [11] .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative awareness and experience with a ketamine-based anaesthesia package to support emergency and essential surgery when no anaesthetist is available

Villegas

Suárez

Owuor

et al. 2019

African Journal of Emergency Medicine

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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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Evaluation of a ketamine‐based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available

Abstract: The ESM-Ketamine package can be safely used by trained non-anesthetist providers to support emergency cesarean delivery and emergency laparotomy when no anesthetist is available.

Cited by 4 publications

References 14 publications

Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis

Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis

Evaluation of Interventions Addressing Timely Access to Surgical Care in Low‐Income and Low‐Middle‐Income Countries as Outlined by the LANCET Commission 2030 Global Surgery Goals: A Systematic Review

Intraoperative awareness and experience with a ketamine-based anaesthesia package to support emergency and essential surgery when no anaesthetist is available

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