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Published on: January 7, 2019
The effect of ketamine on emergence agitation in children: A systematic review and meta-analysis
Ka Ting Ng1, Deep Sarode2, Yuen Sin Lai1
1Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Ketamine may reduce emergence agitation in children undergoing surgery, but evidence quality is low. The drug was well-tolerated, showing no significant adverse effects in this meta-analysis.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Emergence agitation is a concern in pediatric surgery.
- Ketamine's efficacy in preventing this is debated, with conflicting trial results.
Purpose of the Study:
- To systematically investigate the effect of ketamine on emergence agitation in pediatric patients.
- To evaluate secondary outcomes including pain and adverse events.
Main Methods:
- A meta-analysis of 13 randomized controlled trials comparing intravenous ketamine with placebo.
- Searched MEDLINE, EMBASE, and CENTRAL databases up to February 2019.
- Primary outcome: incidence of emergence agitation; Secondary outcomes: pain, discharge time, adverse effects.
Main Results:
- Ketamine use was associated with a significantly lower incidence of emergence agitation (14.7% vs 33.3%).
- Lower postoperative pain scores and Pediatric Anesthesia Emergence Delirium (PAED) scale scores were observed with ketamine.
- No significant differences in postoperative nausea, vomiting, desaturation, or laryngospasm were found.
Conclusions:
- High heterogeneity and low certainty of evidence limit definitive recommendations for ketamine in preventing pediatric emergence agitation.
- Ketamine was well-tolerated, with no notable adverse effects reported across the included studies.
Background:
Ketamine is believed to reduce the incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomized controlled trials reported conflicting findings.
Aims:
To investigate the effect of ketamine on emergence agitation in children.
Methods:
Databases of MEDLINE, EMBASE, and CENTRAL were systematically searched from their start date until February 2019. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. The primary outcome was the incidence of emergence agitation. Secondary outcomes included postoperative pain score, duration of discharge time, and the adverse effects associated with the use of ketamine, namely postoperative nausea and vomiting, desaturation, and laryngospasm.
Results:
Thirteen studies (1125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odds ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison with the placebo, ketamine group achieved a lower postoperative pain score (odds ratio: -2.42, 95% confidence interval: -4.23 to -0.62, certainty of evidence: very low) and lower pediatric anesthesia emergence delirium scale at 5 minutes after operation (odds ratio: -3.99, 95% confidence interval: -5.03 to -2.95; certainty of evidence: moderate). However, no evidence was observed in terms of incidence of postoperative nausea and vomiting, desaturation, and laryngospasm.
Conclusion:
In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. However, the use of ketamine is well-tolerated without any notable adverse effects across all the included trials.
Prospero Registration:
CRD42019131865.
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