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Case Study 2: Ketamine in low resource settings - Tonga

on Monday, 16 November 2015. Posted in 2015

Case Study 2: Ketamine in low resource settings - Tonga

“Our doctors here are really used to using ketamine. It is often used in our emergency department, for anyone who needs sedation and pain relief. As the only anaesthetist here, it makes my job a lot easier.”

The South Pacific nation of Tonga has 36 inhabited islands, spread over 740 square kilometres.

Having a trained anaesthetist on each, let alone a hospital is not feasible. This makes ketamine vital for Tongans. Doctors on the small islands are trained to use it for short procedures, and also in cases where a patient needs to make the journey of up to three hours by plane to a bigger hospital.

“On the islands outside the main hospital they use ketamine a lot, for sedation and small procedures,” says Dr Selesia Fifita, the only anaesthetist on Tonga’s main island, Tongatapu. “It alsohelps them to do whatever they can to help a patient in terms of pain relief and sedation on an island before transferring them.”

Ketamine raises blood pressure and acts quickly which makes it the anaesthetic agent of choice on patients who have lost a lot of blood. This sets it apart from other anaesthetics, which lower blood pressure.

Even at the country’s main hospital Vaiola, in the capital, Nuku’alofa, Dr Fifita regularly uses ketamine, especially for emergency obstetric patients or patients who have been in car accidents.

She’s lost count of how many mothers giving birth the hospital has saved using ketamine.

“Our doctors here are really used to using ketamine,” says Dr Fifita. “It is often used in our emergency department, for anyone who needs sedation and pain relief. As the only anaesthetist here, it makes my job a lot easier.”

Diabetes is a major health problem in Tonga. For short procedures to treat diabetic ulcers and infections Dr Fifita uses ‘ketafol’ – a mix of ketamine and propofol, which is an anaesthetic that, like ketamine, has fast onset. She says she has almost never seen anyone emerge from a ketamine anaesthetic hallucinating, which can be a side effect of the medicine. To reduce the risk of hallucinations, she gives patients a small amount of a sedative.

“Our patients are really satisfied,” she says. “No one has complained to me about ketamine.”