2021 Volume 57 Issue 1 Pages 31-36
Ketamine hydrochloride has been regulated as a narcotic drug in Japan since 2007, although it has been placed on the WHO Model List of Essential Medicines. To evaluate the efficacy and safety, we reviewed 32 cases in which intravenous anesthesia with ketamine was given in the maternity ward of our hospital between January 2007 and December 2018.
In 22 cases, manual extraction of the placenta was performed. Blood loss was between 130 ml and 2100 ml （mean: 1096 ml）. No women had blood transfusion. The other cases include instrumental placental extraction and/or uterine balloon tamponade（3 cases）, hemostatic treatments for vaginal laceration or hematoma（4 cases）, and repair of the third or fourth degree of perineal laceration（3 cases）. Although 5 women needed blood transfusion, all the women recovered well after the treatments.
The dosage of ketamine was between 30 mg and 80 mg（mean: 43 mg）. It was administered alone in 27 cases, and with other sedative or analgesic agents in 5 cases. Sufficient analgesic/anesthetic effects were obtained in all the cases. There were no cases of acute hypotension, respiratory arrest, aspiration, or subsequent drug addiction. No adverse effects were noted in the infants breastfed by the mothers who were anesthetized with ketamine.
Although ketamine has a favorable efficacy and safety profile in cases of obstetric emergencies, there is a major obstacle in the timely and prompt use of ketamine in Japan. The regulation of ketamine as a narcotic drug should be reconsidered from the viewpoint of maternal lifesaving.
