The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy

Abstract

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.

Experience with diagnostic laparoscopy for gynecological indications

“…All the procedures were performed following an overnight fast and under ketamine general anesthesia by the author. [4] During the procedure, the patient is anesthetized and placed in lithotomy trendelenburg position. The abdomen, perineum, and vagina are cleansed and draped leaving only the umbilical area and the vulva.…”

“…It is performed to evaluate the female reproductive system or other gynecological complaints like chronic pelvic pain. [1][2][3] Diagnostic laparoscopy is traditionally done in operating theatre under general anesthesia; [4] though there has been reports of use of local anesthesia with sedation for office laparoscopy. [5,6] The procedure takes between 20 and 30 min and the patients are usually discharged from the hospital the same day.…”

Toxic effect of chloromycetin on the ultrastructures of the motor neurons of the Chinese tree shrew (Tupaia belangeri)

“…Although concerns are often expressed regarding the effect of anesthetics on experimental results, it has been demonstrated that general anesthesia using ketamine is safe and effective (Ikechebelu et al 2003). In this study, the ketamine dose was kept as low as possible for the purposes of physiological observation.…”

Day case surgery in Nigeria

“…[6,20] However, in developing countries like Nigeria, Ikechebelu and colleagues reported that ketamine is still commonly used in private hospitals where there is lack of qualified anesthetists and facilities. [21] Therefore, they suggested that ketamine could safely be used as it produces effective simple anesthesia, especially for day case laparoscopies.…”