Ketamine and the OB patient

  1. Just heard a very scary story today by some of my students. At one of the major teaching facilities over here, in vaginal forceps deliveries, they are using Ketamine, no anesthesia person in the room. The dose, I think that they said 50 mg, was being administered by the nurse in the room on the order of the obstetrician. And this nurse is not trained in anesthesia. No ketamine protocol being followed.
    What are your feelings on this? :uhoh21:
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  2. 11 Comments

  3. by   athomas91
    my feelings are pity for that nurse when something goes wrong....this is where nurses need to be pro-active in patient care in not just trusting any order a doc gives just because he/she's a doc.
  4. by   suzanne4
    Unfortunately over on this side of the world, the doc is considered "G-d like" and you are supposed to do what ever they say. Definitely wouldn't be me!
    But the scariest is having an OB doc order it, who has never done any anesthesia training. And this hospital actually has a training program for MDAs.
    Go figure.................
  5. by   SmilingBluEyes
    Ketamine is only used by trained anethesia personnel here where I work, with damn good reason. I would NOT follow that order were I the OB nurse. But that is here where I work, where we KNOW better.
    Last edit by SmilingBluEyes on May 11, '04
  6. by   suzanne4
    That is exactly what I told my students. You should have seen the look on my face when they were telling me about what was used. I want to be able to give them this thread and show them that it isn't only my opinion. One of my students happens to be a nurse anesthetist, but of course, at another hospital.
  7. by   mother/babyRN
    Cheesh...That scares the heck out of me......Good luck to you! What happens to the nurse in other parts of the world if he or she refuses to go along?
  8. by   suzanne4
    That is a big problem..................they don't refuse, and I don't think that it would be accepted. My students know that they have the right to refuse.
    Hopefully I will be able to get things changed over here, but it will be slow.
    V e r y S l o w ...............
  9. by   mother/babyRN
    Bully for you for being an advocate for things being done right for your patients...I applaud you.....Martha My dad lived over there for a year in 1969...He told us it was absolutely beautiful......I lived in Taiwan twice and hope someday to visit Thailand as well.....
  10. by   alansmith52
    I ve heard it all. did the nurse become concernded at all when the patiet stoped responding and went into a cataleptic state. if she wasn't concerned I'd say it wasn't her first time to that rodeo. (I am speaking of course from the assumption that the nurse had no idea what she was giving)

    Quote from mother/babyRN
    Bully for you for being an advocate for things being done right for your patients...I applaud you.....Martha My dad lived over there for a year in 1969...He told us it was absolutely beautiful......I lived in Taiwan twice and hope someday to visit Thailand as well.....
  11. by   alansmith52
    hmmmph.
    next time I am coaching my wife through labor I'll have to keep this little technique in mind. maybe Ill get less mean looks.

    takes the work out of coaching.

    could she still say she "went natural" ??

    was the patient mentally chalanged or is this standard for a forcept delivery.
  12. by   lady_jezebel
    Strange, I was just reading last night about how ketamine can be used to induce near-death experiences. It triggers something in the brain. Supposedly it alone does not sedate the patient -- it needs to be administered with a sedative to do that. But what will just the administration of ketamine do to the pt?? It will control the pain, but will it additionally cause hallucinations? I feel sorry not just for the nurse, but also the patient.

    For anyone who is interested about ketamine and nde's:
    http://leda.lycaeum.org/?ID=9260

    Excerpt:
    Ketamine is a short-acting, hallucinogenic, 'dissociative' anaesthetic. The anaesthesia is the result of the patient being so 'dissociated' and 'removed from their body' that it is possible to carry out surgical procedures. This is wholly different from the 'unconsciousness' produced by conventional anesthetics, although ketamine is also an excellent analgesic (pain killer) by a different route (i.e. not due to dissociation). Ketamine is related to phencyclidine (PCP). Both drugs are arylcyclohexylamines - they are not opioids and are not related to LSD. In contrast to PCP, ketamine is relatively safe, is much shorter acting, is an uncontrolled drug in most countries, and remains in use as an anaesthetic for children in industrialised countries and all ages in the third world as it is cheap and easy to use (White et al., 1982). Anaesthetists prevent patients from having NDE's ('emergence phenomena') by the co-administration of sedatives which produce 'true' unconsciousness rather than dissociation (Reich and Silvay, 1989.)
    Last edit by lady_jezebel on May 11, '04
  13. by   suzanne4
    Appararently it is a standard for some private doctors at one of the biggest teaching facilities here. In Thailand, most deliveries are done my midwives, with the doctors only doing complicated cases, or private pay patients.
    But the thing that I find the most odd is that this hospital has a well respected anesthesia MDA program, and how is their anesthesia dept letting them get away with it? The doctors (ob/gyn) that are ordering it are using it for forceps deliveries. I don't know anyhting about the nurses giving it, other than they are not anesthetists.............
    My nurses haven't been involved with this since two of them are on post partum, not actually in the Delivery Room.

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