The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy

Abstract

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50 – 180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.