A ketamine package for use in emergency cesarean delivery in the unavailability of an anesthetist.

The present study evaluated the safety and effectiveness of a ketamine-based anesthesia package to support emergency cesarean section in the unavailability of an anesthetist.

The study was conducted across nine sub-county hospitals in Kenya, where Non-anesthetist healthcare providers undertook an evidence-based five-day training course. It measured maternal and newborn survival and the ability of the ketamine package (ESM-Ketamine) to support cesarean deliveries safely. It collected preoperative, intraoperative, and postoperative data and contacted patients six months after surgery to collect outcomes.

The study observed-

• Conduction of 401 emergency cesarean sections using ketamine, administered by 54 non-anesthetist providers.
• All mothers survived to discharge. 
• Reports of brief oxygen desaturations among 8.2% of mothers and agitation and hallucinations among 3.2%.
• No maternal serious adverse events. 
• At the 6-month follow-up, 94.2% of the mothers(who could be contacted) reported no complaints. 
• 92.4% of the 435 operative births survived to discharge.

This study shows that trained non-anesthetist providers can use the ESM-Ketamine package to support emergency cesarean sections in the unavailability of an anesthetist. Ketamine can potentially increase access to emergency cesarean deliveries in resource-limited settings.

Burke TF, Mantena S, Opondo K, Orero S, Rogo K. A ketamine package for use in emergency cesarean delivery when no anesthetist is available: An analysis of 401 consecutive operations. International Journal of Gynecology and obstetrics. 2021;158(2):377-384. https://doi.org/10.1002/ijgo.13965