PDF(Pubmed)
Abstract：
BACKGROUND: Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled.
METHODS: This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach.
RESULTS: The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants.
CONCLUSIONS: Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.
METHODS: This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach.
RESULTS: The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants.
CONCLUSIONS: Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.
摘要：
背景：对于生活在撒哈拉以南非洲的人们来说，获得麻醉和手术护理是一个主要问题。在这个地区,氯胺酮对于提供麻醉护理至关重要。然而,在国际上控制氯胺酮作为受控物质的努力可能会极大地影响其可得性。因此，这项研究旨在评估氯胺酮在撒哈拉以南非洲的麻醉和手术护理中的重要性，并评估如果计划使用氯胺酮对获得氯胺酮的潜在影响。
方法：这项研究是一项混合方法研究，包括卢旺达医院层面的横断面调查，以及与撒哈拉以南非洲麻醉护理专家的关键线人访谈。从卢旺达的医院（n=54）收集了四种麻醉剂的可用性数据。对10名主要举报人进行了半结构化访谈,收集有关氯胺酮重要性的信息，在国际上安排氯胺酮的潜在影响，以及关于滥用氯胺酮的意见。访谈被逐字转录，并使用专题分析方法进行分析。
结果：在卢旺达进行的调查发现，氯胺酮和异丙酚的可利用性约为80％，而硫喷妥钠和吸入剂只有大约一半的医院可用。确定了阻碍获得麻醉护理的重大障碍，包括政府普遍缺乏对专业的关注，麻醉师的短缺和训练有素的麻醉师的迁移，以及药品和设备的匮乏。由于这些障碍，氯胺酮被描述为对提供麻醉护理至关重要。线人认为滥用氯胺酮不是问题。
结论：氯胺酮对于在撒哈拉以南非洲提供麻醉护理至关重要，并且其时间安排将对其用于麻醉护理的可用性产生重大负面影响。
方法：这项研究是一项混合方法研究，包括卢旺达医院层面的横断面调查，以及与撒哈拉以南非洲麻醉护理专家的关键线人访谈。从卢旺达的医院（n=54）收集了四种麻醉剂的可用性数据。对10名主要举报人进行了半结构化访谈,收集有关氯胺酮重要性的信息，在国际上安排氯胺酮的潜在影响，以及关于滥用氯胺酮的意见。访谈被逐字转录，并使用专题分析方法进行分析。
结果：在卢旺达进行的调查发现，氯胺酮和异丙酚的可利用性约为80％，而硫喷妥钠和吸入剂只有大约一半的医院可用。确定了阻碍获得麻醉护理的重大障碍，包括政府普遍缺乏对专业的关注，麻醉师的短缺和训练有素的麻醉师的迁移，以及药品和设备的匮乏。由于这些障碍，氯胺酮被描述为对提供麻醉护理至关重要。线人认为滥用氯胺酮不是问题。
结论：氯胺酮对于在撒哈拉以南非洲提供麻醉护理至关重要，并且其时间安排将对其用于麻醉护理的可用性产生重大负面影响。
