RESUMEN
Background Prior to the COVID-19 Pandemic ketamine’s wide safety margin led to its use as a sole anesthetic agent in resource-limited settings when no anesthetist was available. During this time of the Pandemic the use of ketamine has increased, however there are few recommendations on approaches to intraoperative challenges associated with ketamine’s unique properties. The objective of this study was to gain surgeons’ perceptions on performing operations supported by ketamine and to recommend best practices and techniques. Methods A qualitative study was conducted using semi-structured interviews of surgeons experienced with performing operations supported with ketamine as the sole anesthetic agent. Interviews continued until thematic saturation. Open-response data was analyzed using thematic analysis as well as iterative group discussions about emergent themes. Results Sixteen surgeons were interviewed regarding their operative experiences supported by ketamine across 12 countries. Surgeons universally felt that ketamine is safe, saves lives, and that they would administer it to a loved one in support of an operation if no anesthetist was available. Although lack of muscle relaxation with ketamine may require additional strategies to gain exposure, few surgical technical changes are necessary. While ketamine side effects are manageable, a single provider must always be dedicated to ketamine administration and patient monitoring. Surgeons should advocate for global policies, training and access. Conclusion Ketamine is safe, can provide increased access to emergency and essential surgery, and requires few operative technical changes. Global standards on Ketamine training and use should be established.
RESUMEN
COVID-19 is devastating health systems globally and causing severe ventilator shortages. Since the beginning of the outbreak, the provision and use of ventilators has been a key focus of public discourse. Scientists and engineers from leading universities and companies have rushed to develop low-cost ventilators in hopes of supporting critically ill patients in developing countries. Philanthropists have invested millions in shipping ventilators to low-resource settings, and agencies such as the World Health Organization and the World Bank are prioritizing the purchase of ventilators. While we recognize the humanitarian nature of these efforts, merely shipping ventilators to low-resource environments may not improve outcomes of patients and could potentially cause harm. An ecosystem of considerable technological and human resources is required to support the usage of ventilators within intensive care settings. Medical-grade oxygen supplies, reliable electricity, bioengineering support, and consumables are all needed for ventilators to save lives. However, most ICUs in resource-poor settings do not have access to these resources. Patients on ventilators require continuous monitoring from physicians, nurses, and respiratory therapists skilled in critical care. Health care workers in many low-resource settings are already exceedingly overburdened, and pulling these essential human resources away from other critical patient needs could reduce the overall quality of patient care. When deploying medical devices, it is vital to align the technological intervention with the clinical reality. Low-income settings often will not benefit from resource-intensive equipment, but rather from contextually appropriate devices that meet the unique needs of their health systems.