Ketalar Anesthesia in Surgical Operations: An Experience of Sierra Leone

Yıl 2018, , 84 - 87, 18.05.2018

Orhan Alimoğlu , Metin Leblebici , Tuba Atak Jülide Sağıroğlu , Yadigar Yılmaz Ercüment Tombalak Elif Demirci Muhammet İhsan Karaman

https://doi.org/10.21673/anadoluklin.334933

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 10^th to 16^th
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

Ketamine; Surgery; Hernia repair

Cerrahi işlemlerde ketalar anestezi: Sierra Leone deneyimi

Öz

Giriş

            Yüksek doz ketamin genel anestezide
ve düşük doz analjeziyi indüklemek için kullanılır. Damar içi ketamin
anestezisi, genellikle herni onarımı için kullanıldığı gibi, aynı zamanda da
kutanöz müdahalelerde, jinekolojide dilatasyon ve küretajda ve ürolojide
hidrosel onarımında da kullanılır.

 

Yöntemler

            Bu çalışma, 10 ile 16 Mart 2014
tarihleri ​​arasında Sierra Leonede Yeryüzü Doktorları gönüllü cerrahi ekibi
tarafından ameliyat edilen 49 hastanın sonuçlarını bildirmektedir. Tüm
hastaların demografik özellikleri ve uygulanan cerrahi yöntemler kaydedildi.
Tüm hastalar ketamin anestezi altında ameliyat edildi.

 

Bulgular

            Ortalama yaşları 36.8 ± 17.8 olan
beş kadın ve 44 erkek hasta ameliyat edildi. Bir hastada umblikal herni,
birinde epigastrik ve 35'inde inguinal herni saptandı. Umbilikal ve epigastrik
hernilere primer tamir yapıldı. İnguinal hernilerin 19' u sağ taraftaydı ve 16’
sı sol taraftaydı. Yirmi sekiz hastada indirekt herni vardı, 6 hastada direkt
ve 1 hastada bilateral fıtık vardı. Hiçbir hastada obstrüksiyon veya boğulma
görülmedi. Çocuk yaşta fıtığı olan dört hastaya high ligasyon yapıldı. Yetişkin
yaş grubunda 28 hastaya ağ örme ameliyatı ve 3 hastaya Bassini tamiri yapıldı.
Dört hastanın sağ tarafına, dört hastanın sol tarafına hidrosel için Winkelmann
işlemi uygulandı. Bir hastaya testiste kitle için orşiektomi uygulandı; 1 hastada
inguinal bölgede tümör saptandı ve rezeksiyonu yapıldı; bir hastada boyunda
lipom eksizyonu ve bir hastada sol labium majusta kitle eksizyonu yapıldı. Hiçbir
hastada anestezi ile ilgili komplikasyon gelişmedi.

 

Sonuç

            Düşük doz intravenöz ketamin ve
midazolam ile güvenli ve etkili sedasyon özellikle cerrahi anestezinin
uygulanamadığı saha koşullarında cerrahi prosedürlerde yararlıdır.

Anahtar Kelimeler

Ketamin; Cerrahi; Herni

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.
• 11. Chu K, Maine R, Trelles M. Cesarean Section Surgical Site Infections in Sub-Saharan Africa: A Multi-Country Study from Medecins Sans Frontieres. World J Surg 2014 Oct 31; DOI:10.1007/s00268-014-2840-4
• 12. Wong EG, Kamara TB, Groen RS, Zogg CK, Zenilman ME, Kushner AL. Prevalence of surgical conditions in individuals aged more than 50 years: a cluster-based household survey in sierra leone. World J Surg 2015 Jan;39(1):55-61.
• 13. Groen RS, Samai M, Stewart KA, Cassidy LD, Kamara TB, Yambasu SE, et al. Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 2012 Sep 22;380(9847):1082-7.
• 14. Garip H, Gürkan Y, Toker K, Göker K. A comparison of midazolam and midazolam with remifentanil for patient-controlled sedation during operations on third molars. Br J Oral Maxillofac Surg 2007;45:212-6.
• 15. Morse Z, Sano K, Kanri T. Effects of a midazolam-ketamine admixture in human volunteers. Anesth Prog 2004;51:76-9.
• 16. Esen E, Üstün Y, Balcıoğlu O, Alparslan ZN. Evaluation of Patient Controlled Remifentanil Application in Third Molar Surgery. J Oral Maxillofac Surg 2005, 63:457-63. 17. Bonanno FG. Ketamine in war/tropical surgery (a final tribute to the racemic mixture). Injury 2002 May;33(4):323-7.
• 18. Roelofse JA, Joubert JJ, Roelofse PG. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg 1996;54:838-44.