A Ketamine Package for Use in Emergency Cesarean Delivery When No Anesthetist is Available: An Analysis of 401 Consecutive OperationsAnesthesia and AnalgesiaAnesthesia and Analgesia

( Int J Gynecol Obstet . 2022;158:377–384) Average maternal mortality in low-income countries has been reported as 40 times higher than that of high-income countries. One contributing factor to this discrepancy is the shortage of surgical care either due to inaccessible resources or inaccessible clinicians such as anesthesiologists. There is a particularly noticeable gap in anesthesiology care, as most low-income countries do not have anesthesiology training programs, or the programs do not produce enough clinicians to fully staff what is needed. This study aimed to understand the implications of using ketamine as an anesthetic to support emergency surgical delivery if no anesthetist is available. Effectiveness and safety was evaluated through maternal and newborn outcomes. The primary outcome was maternal and infant survival, and the ability of ketamine to safely support cesarean deliveries (CD).