An innovative safe anesthesia and analgesia package for emergency pediatric procedures and surgeries when no anesthetist is available

Abstract

BackgroundAdequate pain control through sedation and anesthesia for emergency procedures is a crucial aspect of pediatric emergency care. Resources for administering such anesthesia are extremely limited in many low-income settings.MethodsNon-anesthetist providers in Western Kenya were trained in the use of a ketamine-based sedation and anesthesia package for non-anesthetists, Every Second Matters for Mothers and Babies-Ketamine™ (ESM-Ketamine). Data on use and safety of this package for emergent and urgent pediatric procedures was collected. Providers were surveyed as to what they would have done for similar procedures if the ESM-Ketamine package were unavailable.ResultsNinety procedures were completed for 77 pediatric patients utilizing the ESM-Ketamine package. Of these, 29 (32.2 %) cases were orthopedic reductions, 19 (21.1 %) were incision and drainage, and 19 (21.1 %) were debridement and irrigation of burns. Remaining cases included cesarean section, repair of perineal tear, foreign body removal, arthrocentesis, laceration repair, exploratory laparotomy, excision of mass, paracentesis, and circumcision. There were no serious adverse events in any of the cases, 17 % experienced minor adverse events including hypersalivation, hallucinations, or brief, self-resolving, oxygen desaturations. Providers were surveyed for 80 of the 90 cases as to what they would have done in the absence of the ESM-Ketamine package: in 26 cases (32.5 %), they reported they would proceed with the procedure without any anesthesia or analgesia; in 15 (18.75 %), they reported they would significantly delay the procedure while waiting for an anesthetist; in 13 (16.25 %), they reported they would attempt referral to another facility; and in 26 (32.5 %), they reported they would try using an alternate form of analgesia, primarily acetaminophen, ibuprofen, diclofenac, and/or diazepam. All surveyed providers reported they would use the ESM-Ketamine package again in similar cases.ConclusionsThe ESM-Ketamine package, through the use of a simplified protocol and checklist, allows for safe analgesia and anesthesia in children by non-anesthetists in a resource-limited setting for selected emergent and urgent procedures. This package addresses a significant gap in the availability of anesthesia services in low-income settings that would otherwise result in significant delays to procedures or proceeding with painful procedures with inadequate analgesia.

Effect of ketamine combined with lidocaine in pediatric anesthesia

“…During operation process, inadequate pain control may lead to incomplete procedure and adverse complications. 1 To facilitate a higher success rate, a majority of procedures are performed under anesthetic effect, especially for uncooperative circumstances among children. 2,3 Therefore, administering an appropriate degree of anesthesia to cope with the procedural demands remains a challenge for the anesthesiologist.…”

A basic anesthesia training program for nurses in Chad: first steps for a south–south academic cooperation program

“…21 The lack of anesthesia-trained workforce in Chad is huge. Many educational interventions have been proposed to address this kind of gap, from five-day brief courses 17,32 to full training programs 10 certified by local authorities. Our program offers a reasonable alternative and might serve as a bridge solution for training nurses intensively and efficiently to provide anesthesia for common procedures.…”

“…[10][11][12][13][14][15][16] Despite this, no internationally validated training programs for non-physician anesthesia providers (NPAPs) have been proposed for LMIC with a wide range of designs, methodologies, and structures implemented worldwide. 10,13,17 Chad is a landlocked sub-Saharan African country. Its population is approximately 14 million people, with a per capita gross national income of 720 USD per year.…”

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

“…described the delivery of PSA training to nurses in Uganda and showed that 191 PSA cases were safely carried out by six nurses who participated in the training. Another project of teaching and implementing a simplified protocol and checklist for ketamine for PSA has been described by Schwartz et al . Our approach was different from these projects in that we recruited local Japanese physicians to develop and deliver the training sessions.…”