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Cited by 25Global Health and SurgeryAnesthesia and Sedative AgentsAnesthesia and Pain Management

The DOI matches its Crossref record; 27 of the 31 references it cites were found in a registry or an index.

The Role of Ketamine in Low- and Middle-Income Countries: What Would Happen if Ketamine Becomes a Scheduled Drug?

Joshi, Girish P., Onajin-Obembe, Bisola·2016·Anesthesia & Analgesia
DOI 10.1213/ane.0000000000001104
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Abstract

More than 2 billion of the world’s population reside in low- and middle-income countries. In these countries, provision of emergency, essential surgical care, and anesthesia that have been shown to decrease mortality and disability is limited.1,2 One of the reasons could be that providing anesthesia in these countries can be challenging because of inadequate infrastructure and equipment. In addition, these countries have a shortage of trained anesthesiologists, and thus, nonphysician anesthesia providers generally provide anesthesia services in the rural and underserved hospitals.3–5 In such circumstances, it is necessary to use anesthetic drugs and techniques with safe profiles. Ketamine in Low- and Middle-Income Countries Ketamine is a potent dissociative anesthetic and analgesic with a 50-year history of clinical utility.6–8 It provides analgesia, amnesia, immobility, and loss of consciousness. It has a wide margin of safety when compared with other general anesthetics. Its sympathomimetic effects provide hemodynamic stability, which is of particular benefit in hemodynamically unstable and critically ill patients.9,10 In addition, it has bronchodilatory properties, which contribute to its safety in patients with acute pulmonary disease. Also, during ketamine anesthesia, pharyngeal and laryngeal reflexes, as well as ventilation, are generally preserved. Ketamine stimulates respiration and maintains airway patency during sedation and anesthesia over a wide dose range.11 Low-dose ketamine has been shown to antagonize opioid-induced hypoventilation in healthy volunteers.12 Ketamine can be used for coinduction with other anesthetics, thereby enhancing their synergistic action and providing cardiopulmonary stability.13,14 In addition, ketamine has been shown to be superior to fentanyl with respect to hemodynamic stability and adverse effects.15 Ketamine also minimizes the decrease in core temperature usually associated with anesthesia because it reduces the magnitude of redistribution hypothermia.16 Overall, ketamine is suitable in many clinical situations because of its safety profile (i.e., wide therapeutic range, as well as preservation of airway reflexes, ventilation, and hemodynamic stability) and suitability for administration via multiple routes (e.g., IV, IM, and intraosseous).17 It is inexpensive and easily available, and unlike modern anesthetic techniques such as inhaled anesthesia, it requires minimal equipment and training. Therefore, in many low- and middle-income countries, ketamine is the sole anesthetic. Ketamine has been shown to be safe and effective for a wide range of surgical procedures, including short painful, long complex, and day-case procedures.18–20 Ketamine is used in all age groups, including neonates, infants, and children. In most peripheral hospitals in the low- and middle-income countries, ketamine remains the commonly used premedicant and anesthetic for pediatric patients undergoing a variety of surgical procedures.21–23 A systematic review of published literature found that caudally administered ketamine, in addition to a local anesthetic, provided prolonged postoperative analgesia with few adverse effects compared with local anesthetics alone.24 Médecins Sans Frontières, in its projects covering >50 countries around the world, uses ketamine as a component of multimodal analgesia, which includes tramadol and diclofenac, with good results.25 Although not all countries have the same levels of reliance on ketamine as an anesthetic, in resource-poor environments and in crisis, there is no substitute that is either as effective or as safe. Thus, even the rich countries that currently are not dependent on ketamine may require it in a crisis (i.e., disaster medicine and prehospital analgesic/anesthetic). The unique properties of ketamine make it appealing for prehospital analgesia and anesthesia (e.g., surgical procedures for acute life-threatening situations such as managing major hemorrhage and traumatic amputations and to facilitate patient extrication), as well as in disaster and limited resource situations. Similarly, ketamine has an established role for challenging situations in the emergency department, including procedural sedation, difficult airway, reactive airway disease, and the uncooperative patient, as well as for fracture management and burn analgesia.26,27 Ketamine lends itself to creative and innovative modes of administration. For example, 5 mg/kg oral ketamine sweetened with soda has been used for the reduction of fractures.28 The authors concluded that ketamine in soda appears to be palatable with a rapid onset of action and few side effects, while being an inexpensive and accessible option for effective analgesia for minor procedures in the emergency room.28 Ketamine Abuse and Scheduling Unfortunately, ketamine is used recreationally, as a “party drug.”29 There are a number of harms stemming from the chronic, recreational use of ketamine.30,31 There is also con

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Research works printed but not linked: 3

  1. Olasinde, 2005, Anesthesia practice in a hospital, developing countries: an 18 months experience., Intl J Third World Med, 3, 1
  2. Elusoji, 2009, Thyroidectomy under ketamine anaesthesia in a semi urban hospital in Nigeria., Pak J Med Sci, 25, 695
  3. Alagbe-Briggs, 2013, Experience with ambulatory anaesthesia for paediatric inguinoscrotal surgery in a surgical outreach., J Med Med Sci, 4, 225

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Metadata

Authors
Joshi, G. P., & Onajin-Obembe, B.
Affiliations
University of Port Harcourt Teaching Hospital (NG)
Corresponding author
Joshi, Girish P.
ORCID
Joshi, Girish P.
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-03
Volume
122
Issue
3
Pages
908-910
ISSN
0003-2999 (ISSN-L)
DOI
10.1213/ane.0000000000001104
OpenAlex
W2477498883
Cited by
25
References
31
Citations by year
2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 1 · 2018: 3 · 2017: 5
FWCI
2.65
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Keywords
ketamine, low- and middle-income countries, emergency surgery, anesthesia safety, hemodynamic stability, airway reflexes, intraosseous administration, anesthesiologist shortage, regional anesthesia, analgesia
MeSH terms
Anesthetics, Dissociative, Developing Countries, Drug Utilization, Humans, Ketamine, Controlled Substances

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