Feasibility of a Ketamine Anesthesia Package in Support of Obstetric and Gynecologic Procedures in Kenya When No Anesthetist is Available

Charles O. Masaki, Jennifer Makin, Sebastian Suarez, Gabriella Wuyke, Ayla N. Senay, Daniela Suarez-Rebling, Javan Imbamba, Jackton Juma, Moytrayee Guha, Thomas F. Burke


The objective was to assess the feasibility and safety of the ‗Every Second Matters for Emergency and Essential Surgery – Ketamine‘ (ESM-Ketamine) package in support of obstetric and gynecologic emergency and essential surgery when no anesthetist is available. A consecutive case series was conducted in twelve hospitals across five severely resource-limited counties in Kenya. 530 women underwent obstetric or gynecological operative procedures supported by non-anesthetist clinicians using the ESM-Ketamine package between November 1, 2013 and September 30, 2017. Main outcomes included reasons for ESM-Ketamine activations and ketamine-related adverse events. There were two (0.4%) prolonged (>30 seconds) oxygen desaturations below 92%. Brief oxygen desaturations (<30 seconds) below 92% occurred in 15 (2.8%) cases and 113 (21.3%) were administered diazepam to treat hallucinations or agitation. There were no ketamine-related deaths or injuries. The ESM-Ketamine package appears feasible and safe for use in support of obstetric and gynecologic surgeries when no anesthetist is available. (Afr J Reprod Health 2019; 23[1]: 37-45).

Full Text:



Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Merisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G and Yip W. Global Surgery 2030: evidence and

solutions for achieving health, welfare, and

economic development. Lancet 2015;386(9993):569-624.

Anderson RE, Ahn R, Nelson BD, Chavez J, de Redon E and Burke T. Defining the anesthesia gap for reproductive health procedures in resource-limited settings. Int J Gynaecol Obstet 2014;127(3):229-33.

McQueen KA. Anesthesia and the global burden of

surgical disease. Int Anesthesiol Clin 2010;48(2):91-107.

Kenya National Bureau of Statistics (KNBS) and ICF Macro (2010). Kenya Demographic and Health Survey 2008-09. Nairobi, Kenya: KNBS and ICF Macro, 2010.

Burke TF, Hines R, Ahn R, Walters M, Young D, Anderson RE, Tom SM, Clark R, Obita W and Nelson BD. Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya. BMJ Open 2014;4(9):e006132.

Drummond J and Crawford N. Humanitarian crises, emergency preparedness and response: the role of

Ketamine Anesthesia for OBGyn Surgery

business and the private sector, Kenya case study. London, UK: Humanitarian Policy Group, Overseas Development Institute, 2014.

Ahamadani FA, Louis H, Ugwi P, Hines R, Pomerleau M, Ahn R, Burke TF and Nelson, BD. Perinatal health care in a conflict-affected setting: evaluation of health-care services and newborn outcomes at a regional medical centre in Iraq. East Mediterr Health J 2015;20(12):789-95.

Busza J and Lush L. Planning reproductive health in conflict: a conceptual framework. Soc Sci Med 1999;49(2):155-71.

Kempthorne P, Morriss WW, Mellin-Olsen J and Gore-Booth J. The WFSA Global Anesthesia Workforce Survey. Anesth Analg 2017;125(3):981-90.

African Institute for Health Transformation (AIHT). ESM-Ketamine and ESM-UBT Inception Meeting. Mandera and Garissa County Engagement - Field Report, September 26, 2016.

Bosmans M, Nasser D, Khammash U, Claeys P and Temmerman M. Palestinian women's sexual and reproductive health rights in a longstanding humanitarian crisis. Reprod Health Matters 2008;16(31):103-11.

Alkire BC, Vincent JR, Burns CT, Metzler IS, Farmer PE and Meara JG. Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention. PLoS One 2012;7(4):e34595.

Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA and Haynes AB. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Jama 2015;314(21):2263-70.

United Nations Population Fund (UNFPA) Kenya. Counties with the Highest Burden of Maternal Mortality United Nations Population Fund

[Internet], 2014. Available from: http://kenya.unfpa.org/en/news/counties-highest-burden-maternal-mortality.

Burke TF, Suarez S, Sessler DI, Senay A, Yusufali T, Masaki C, Guha M, Rogo D, Jani P, Nelson BD and Rogo K. Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures. World J Surg 2017;41(12):2990-2997

Green SM, Clem KJ and Rothrock SR. Ketamine Safety Profile in the Developing World: Survey of Practitioners. Acad Emerg Med 1996;3(6):598-604.

Bisanzo M, Nichols K, Hammerstedt H, Dreifuss B, Nelson SW, Chamberlain S, Kyomugisha F, Noble A, Arthur A and Thomas S. Nurse-administered ketamine sedation in an emergency department in rural Uganda. Ann Emerg Med 2012;59(4):268-75.

Guldner GT, Petinaux B, Clemens P, Foster S and Antoine S. Ketamine for procedural sedation and analgesia by nonanesthesiologists in the field: a review for military health care providers. Mil Med 2006;171(6):484-90.

Population Dynamics, Environment, and Sustainable Development in Siaya County. Washington, DC: Population Action International - Healthy Families Healthy Planet, 2013.

Craven R. Ketamine. Anaesthesia 2007;62(Suppl 1):48-53.

Burke TF, Nelson BD, Kandler T, Altawil Z, Rogo K, Imbamba J, Odenyo S, Pinder L, Lozo S, Guha M and Eckardt MJ. Evaluation of a ketamine-based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available. Int J Gynaecol Obstet 2016;135(3):295-98.

Dich-Nielsen J and Holasek J. Ketamine as induction agent for caesarean section. Acta AnaesthesiolScand 1982;26(2):139-42.

Schwartz KR, Fredricks K, Al Tawil Z, Kandler T, Odenyo SA, Imbamba J, Nelson BD and Burke TF. An innovative safe anesthesia and analgesia package for emergency pediatric procedures and surgeries when no anesthetist is available. Int J Emerg Med 2016;9(1):16.

Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC and Losek JD. Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children. Ann Emerg Med 2009;54(2):171-80.e1-4.

Pai A and Heining M. Ketamine. CEACCP



  • There are currently no refbacks.