The Effect of Different Propofol-Ketamine Combinations on Emergence Delirium in Children Undergoing Adenoidectomy and
Ebru Biricik1, Feride Karacaer1, Demet Laflı Tunay1
1Faculty of Medicine, Department of Anesthesiology and Reanimation, Çukurova University, Adana, Turkey.
Insights
Adding ketamine to propofol during sevoflurane anesthesia induction significantly reduced emergence delirium (ED) and pain in children. A 3:1 propofol-to-ketamine ratio offered the best recovery, minimizing ED and analgesic needs without increasing PACU stay.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Emergence delirium (ED) is a common and distressing complication in children following sevoflurane anesthesia.
- Effective strategies to prevent ED are crucial for improving pediatric postoperative care.
Purpose of the Study:
- To compare varying ratios of propofol-ketamine combinations for preventing ED in pediatric patients undergoing adenoidectomy and tonsillectomy.
- To identify the optimal propofol-ketamine ratio for minimizing ED and postoperative pain.
Main Methods:
- A prospective, randomized clinical trial involving 112 children aged 3-12 years.
- Four groups received different propofol-ketamine ratios (1:1, 2:1, 3:1) or propofol alone at induction.
- Anesthesia was maintained with sevoflurane; ED was assessed using the Watcha score.
Main Results:
- The 3:1 propofol-ketamine ratio group showed significantly lower incidence of ED compared to other groups.
- ED occurred in 3, 2, 2, and 11 children across Groups I, II, III, and IV, respectively.
- The 3:1 ratio group also required fewer rescue analgesics and had comparable PACU stay durations.
Conclusions:
- Combining ketamine with propofol during sevoflurane anesthesia induction effectively reduces ED and analgesic requirements in children.
- A propofol-to-ketamine ratio of 3:1 is recommended for improved postoperative recovery, characterized by reduced pain and ED.
Purpose:
Emergence delirium (ED) after sevoflurane anesthesia remains a serious issue in children. We aimed to compare different ratios of propofol-ketamine combinations to determine a better option for preventing ED.
Design:
A prospective, randomized clinical trial.
Methods:
In this study, 112 children aged between 3 and 12 years who underwent adenoidectomy and tonsillectomy were recruited. Propofol 1 mg kg-1 + ketamine 1 mg kg-1 (1:1 ratio), propofol 1.5 mg kg-1 + ketamine 0.75 mg kg-1 (2:1 ratio), propofol 2 mg kg-1 + ketamine 0.66 mg kg-1 (3:1 ratio), and propofol 3 mg kg-1 were applied at induction of anesthesia for Groups I, II, III, and IV, respectively. Fentanyl 1 mcg kg-1 and rocuronium 0.6 mg kg-1 were applied at induction, and anesthesia was maintained with sevoflurane and O2/N2O mixture for all participants. Intravenous morphine 0.1 mg kg-1 was applied for postoperative analgesia in the last 10 minutes of surgery. ED was defined as a Watcha score of ≥3. Demographics, hemodynamics, extubation time, Watcha scores, the Face, Legs, Activity, Cry, and Consolability scores, length of stay in the postanesthesia care unit (PACU), rescue analgesic requirement, and postoperative complications were recorded.
Findings:
ED was significantly higher at 10 and 20 minutes in Group IV. Eighteen children experienced ED in PACU, (3, 2, 2, and 11 children in Groups I, II, III, and IV, respectively). Face, Legs, Activity, Cry, and Consolability scores were significantly different at all times. Rescue analgesics were required by 3 children (10.7%) in Group I, 2 (7.1%) in Group II, 2 (7.1%) in Group III, and 10 (35.7%) in Group IV (P = .012). The PACU stay was 21.9 ± 6.4 in Group I, 18.7 ± 6.3 in Group II, 16.7 ± 5.8 in Group III, and 17.4 ± 5.8 in Group IV. Nystagmus was observed in three children in Group I.
Conclusions:
To addition of ketamine to propofol during the induction of sevoflurane anesthesia can reduce the ED and analgesic requirements in children. A propofol-to-ketamine ratio of 3:1 provided better postoperative recovery with less pain and ED, without prolonging the PACU length of stay.
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