Thomas F Burke1,2,3,4, Sebastian Suarez5, Ayla Senay5, Charles Masaki5,6,7, Khama Rogo7,8, Daniel I Sessler9, Taha Yusufali7,10, Debora Rogo7, Moytrayee Guha5,7, Pankaj Jani10,11, Brett D Nelson5,12,7. 1. Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA. tfburke@mgh.harvard.edu. 2. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. tfburke@mgh.harvard.edu. 3. Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. tfburke@mgh.harvard.edu. 4. African Institute for Health Transformation at Sagam Community Hospital, P.O. Box 905-50307, Luanda, Kenya. tfburke@mgh.harvard.edu. 5. Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA. 6. Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. 7. African Institute for Health Transformation at Sagam Community Hospital, P.O. Box 905-50307, Luanda, Kenya. 8. Kenya Obstetrics and Gynaecological Society, P.O. Box 19459-00202, Nairobi, Kenya. 9. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave. - P77, Cleveland, OH, 44195, USA. 10. College of Surgery for East, Central, and Southern Africa, 157 Olorien, Njiro Road, Arusha, Tanzania. 11. Department of Surgery, University of Nairobi School of Medicine, P.O. Box 19676, Nairobi, Kenya. 12. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Abstract
BACKGROUND: Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. METHODS: From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists. RESULTS: Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (<30 s) oxygen desaturations occurred in 39 patients (3%), and prolonged (>30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations. CONCLUSIONS: The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.
BACKGROUND: Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. METHODS: From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists. RESULTS: Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (<30 s) oxygen desaturations occurred in 39 patients (3%), and prolonged (>30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations. CONCLUSIONS: The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.
Authors: R Eleanor Anderson; Roy Ahn; Brett D Nelson; Jean Chavez; Emily de Redon; Thomas Burke Journal: Int J Gynaecol Obstet Date: 2014-08-13 Impact factor: 3.561
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Thomas F Burke; Sebastian Suarez; Ayla Senay; Charles Masaki; Khama Rogo; Daniel I Sessler; Taha Yusufali; Debora Rogo; Moytrayee Guha; Pankaj Jani; Brett D Nelson Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Sarah Villegas; Sebastian Suarez; Joseph Owuor; Gabriella M Wuyke; Brett D Nelson; Javan Imbamba; Debora Rogo; Khama Rogo; Thomas F Burke Journal: Afr J Emerg Med Date: 2018-07-26
Authors: Mary Ellen Gilder; Nay Win Tun; Annabelle Carter; Ferdinand Frederik Som Ling Tan; Aung Myat Min; Hsa Eh; Pan Aye; Verena I Carrara; Chaisiri Angkurawaranon; Rose McGready Journal: BMC Pregnancy Childbirth Date: 2021-02-09 Impact factor: 3.007
Authors: Stephen Charles Resch; Sebastian Suarez; Moshood Olanrewaju Omotayo; Jennifer Griffin; Daniel Sessler; Thomas Burke Journal: BMJ Open Date: 2022-10-05 Impact factor: 3.006