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Effects of S-ketamine on emergence agitation after sevoflurane anesthesia for children: A randomized clinical trial
1Department of Anesthesiology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Insights
S-ketamine effectively reduces emergence agitation (EA) in children after sevoflurane anesthesia for ENT surgery. A lower dose of S-ketamine (0.25 mg/kg) is as effective as propofol but avoids prolonged awakening.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Sevoflurane anesthesia is associated with an increased incidence of emergence agitation (EA) in pediatric patients.
- Emergence agitation poses a clinical challenge, necessitating effective preventive strategies.
Purpose of the Study:
- To evaluate the efficacy of S-ketamine in preventing emergence agitation (EA) following sevoflurane anesthesia in children undergoing otolaryngology procedures.
- To compare the effects of different doses of S-ketamine and propofol on EA incidence and postoperative pain.
Main Methods:
- A randomized controlled trial involving children undergoing otolaryngology surgery.
- Four groups received either normal saline, propofol (2 mg/kg), S-ketamine (0.25 mg/kg), or S-ketamine (0.5 mg/kg) intravenously before operation completion.
- Emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium Scale (PAED) and Face, Legs, Activity, Cry, and Consolability (FLACC) scores.
Main Results:
- S-ketamine (0.25 mg/kg and 0.5 mg/kg) and propofol (2 mg/kg) significantly reduced the incidence of EA compared to normal saline.
- Postoperative FLACC scores at 3 and 6 hours were significantly lower in the S-ketamine groups compared to propofol and saline groups.
- No significant differences in adverse events were observed among the four groups.
Conclusions:
- Intravenous S-ketamine (0.25 mg/kg and 0.5 mg/kg) and propofol (2 mg/kg) are effective in reducing emergence agitation in children after sevoflurane anesthesia for tonsillectomy/adenoidectomy.
- S-ketamine at 0.25 mg/kg offers an advantage by not prolonging awakening time compared to propofol and higher-dose S-ketamine.
Abstract:
BackgroundWith the use of sevoflurane, the incidence of emergence agitation (EA) has also increased.ObjectiveWe aimed to investigate whether S-ketamine can prevent EA after sevoflurane anesthesia in children.MethodsChildren undergoing otolaryngology surgery were assigned to one of four groups randomly. Drugs were given five minutes before the operation was accomplished. The incidence of EA was measured by the Pediatric Anesthesia Emergence Delirium Scale (PAED) scores. Face, Legs, Activity, Cry, and Consolability scale (FLACC) scores and the rate of adverse events were evaluated.ResultsThe incidence of EA was significantly lower in children given 2 mg/kg propofol, 0.25 mg/kg S-ketamine and 0.5 mg/kg S-ketamine compared with that in children given normal saline. At 3 h and 6 h after operation, the FLACC scores in children given 0.25 mg/kg S-ketamine and 0.5 mg/kg S-ketamine were significantly lower than those in children given 2 mg/kg propofol and saline (p < 0.001). No statistical differences were found in adverse reactions among children in the four groups.ConclusionIntravenous injection of propofol 2 mg/kg, S-ketamine 0.25 mg/kg and S-ketamine 0.5 mg/kg before end of the operation can all reduce the incidence of occurrence of emergence agitation in children undergoing tonsillectomy with or without adenoidectomy after sevoflurane anesthesia. Compared with children given propofol 2 mg/kg and S-ketamine 0.5 mg/kg, children given S-ketamine 0.25 mg/kg has the advantage of not prolonging the awakening time.
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