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Case Study 1: Ketamine use in war zones - Syria

on Monday, 16 November 2015. Posted in 2015

Case Study 1: Ketamine use in war zones  - Syria

“It is an anaesthetic and a pain killer. It is very safe and very versatile. There is no other agent out there like it.”

In conflict zones, abandoned homes become hospitals. The kitchen might be turned into a sterilization room. The living room may become an operating theatre. Among the medics manning the hospital may be civilians, helping where they can. The electricity supply can be unreliable at best. In these situations, ketamine is literally a life-saver.

Dr Rachael Craven recalls the night she was working in such a hospital. Near Aleppo in Syria, in 2012 the Médecins Sans Frontiers team she was working with had set up a makeshift 12 bed hospital in a house. Fifteen children were brought in. A bomb had torn apart the basement they were sheltering in. Among them was a nine year old girl, with massive shrapnel injuries.

“We didn’t have any of the complicated equipment that I would have in the UK,” says Dr Craven, an anaesthetist with extensive experience in conflict and disaster medicine.

The lack of a continuous power supply meant sometimes she didn’t even have oxygen – a basic required for safely giving most anaesthetics. Ketamine, however, doesn’t necessarily require oxygen to administer.

“If I’d given her anything other than ketamine to anaesthetise her for surgery, her blood pressure would have absolutely gone down,” says Dr Craven. “I didn’t have the other drugs I would have back home to support her blood pressure or systems to monitor her. She would have died straight away.”

Unlike other anaesthetics, ketamine raises blood pressure and does not depress respiration. For severely injured patients in emergency situations where medical facilities are threadbare, ketamine is the only anaesthetic that can be safely used.

“If I was back home I would have all sorts of extra monitoring, I’d have all sorts of extra drugs I could give to support the blood pressure. When I’m working in disaster or conflict zones, I don’t have any of that,” says Dr Craven. “If I was to give a different type of anaesthetic, the patient would probably arrest and die, whereas with ketamine, you can get them to sleep and keep their blood pressure maintained whilst you get control of the situation.”

“Ketamine in those situations is really a life-saver.”

Ketamine is also a strong and fast-acting pain killer – which makes it helpful before, during and after surgery. It doesn’t require the intensive monitoring of other analgesics. Dr Craven says on that awful night in Syria, it was given to the children hit by the bombing who had to wait for surgery.

“Because it doesn’t repress respiration, it’s very safe. In situations where we’ve got a lot of patients and limited trained staff, that extra safety buffer is really important,” she says.
Dr Craven prizes ketamine for its versatility.

“For ‘resource-poor’ contexts, it is really very safe and very versatile. There is no other agent out there that can do all those things which why it’s such a huge problem if our access to it becomes restricted.”