Ketalar Anesthesia in Surgical Operations: An Experience of Sierra Leone
Öz
Introduction
High dose of ketamine is administered in general anesthesia and low dose is used to induce analgesia. Intravenous ketamine is usually used for hernia repair as well as cutaneous interventions in general surgery, for dilatation and curettage in gynecology, and hydrocele repair in urology.
Materials and Methods
This study reports the outcomes of 49 patients who had been operated by volunteering surgical team of Doctors Worldwide in Sierra Leone during 10th to 16th of March 2014. Demographic features of all patients and surgical methods were recorded. All patients were operated on under ketamine anesthesia.
Results
Five female and 44 male patients with mean age of 36.8+17.8 were operated. One patient had umbilical, 1 had epigastric, and 35 had giant inguinal hernias. Umbilical and epigastric hernias underwent primary repair. Inguinal hernias were right sided in 19, and left sided in 16 patients. Twenty-eight patients had indirect hernias, while 6 had direct and 1 had bilateral hernias. None of the patients appeared with either obstruction or strangulation. Four patients in pediatric age with hernia underwent high ligation. In adult age group, 28 patients were operated by wall darn repair, and 3 had Bassini repair. Four patients had been diagnosed with right sided, and 4 left sided giant hydroceles all of which underwent Winkelmann procedure. One patient had orchiectomy for a right sided testicular mass; 1 had resection of an inguinal tumor; 1 excision of lipoma in the neck, and 1 excision of a solid mass in the left labium majus. None of the patients had complications related to anesthesia.
Conclusion
Safe and effective sedation by low dose intravenous administration of ketamine and midazolam is beneficial in surgical procedures, especially in field conditions where general anesthesia is not applicable.
Anahtar Kelimeler
Kaynakça
- References 1. M. A. Rosen, J. B. Sampson, E. V. Jackson Jr, R. Koka, A. M. Chima, O. U. Ogbuagu, et al. Failure mode and effects analysis of the universal anaesthesia machine in two tertiary care hospitals in Sierra Leone. British Journal of Anaesthesia 2014;113(3):410-5.
- 2. Deng XM, Xiao WJ, Luo MP, Tang GZ, Xu KL. The use of midazolam and small-dose ketamine for sedation and analgesia during local anesthesia. Anesth Analg 2001;93:1174-7.
- 3. Launo C, Bassi C, Spagnolo L, Badano S, Ricci C, Lizzi A, et al. Preemptive ketamine during general anesthesia for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Minerva Anestesiol 2004;70:727-38.
- 4. Morse Z, Kaizu M, Sano K, Kanri T. BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94:420-4.
- 5. Irabor DO. Hernia repair under local or intravenous ketamine in a tropical low socio-economic population. West Afr J Med 2005 Apr-Jun;24(2):143-6.
- 6. Bickler S, Ozgediz D, Gosselin R et al. Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 2010;34:374-80
- 7. Alimoglu O, Eren T, Tombalak E, Leblebici M, Azizoglu S, Sever S, et al. Volunteer Surgical Team in Somalia. Indian J Surg 2017; DOI 10.1007/s12262-017-1626-y
- 8. Alimoglu O, Sagiroglu J, Eren T, Kinik K. Rural surgery in Guinea Bissau: an experience of Doctors Worldwide Turkey. North Clin Istanbul 2015;2(3):196–202
- 9. Kwon S, Groen RS, Kamara TB, Cassidy LD, Samai M, Yambasu SE, et al. Nationally representative household survey of surgery and mortality in Sierra Leone. World J Surg 2013 Aug;37(8):1829-35.
- 10. Blankstein KC. Low-Dose Intravenous Ketamine: An Effective Adjunct to Conventional Deep Conscious Sedation. J Oral Maxillofac Surg 2006;64:691-2.