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The use of ketamine on emergence agitation in children: a systematic review and meta-analysis

Ka Ting Ng1, Jun Chuen Hui2, Wan Yi Teoh1

  • 1University of Malaya, Department of Anaesthesiology, Kuala Lumpur, Malaysia.

Brazilian Journal of Anesthesiology (Elsevier)
|August 30, 2025
PubMed

Insights

Ketamine may reduce emergence agitation and pain in children after surgery, but evidence is limited. Further high-quality trials are needed before routine use can be recommended for pediatric anesthesia.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Ketamine is hypothesized to decrease emergence agitation in pediatric surgical patients.
  • Conflicting findings in recent literature necessitate a comprehensive review.
  • This study aimed to evaluate ketamine's efficacy in reducing emergence agitation in children.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis on ketamine's use for reducing emergence agitation in pediatric surgical patients.
  • To synthesize evidence from randomized controlled trials comparing ketamine with placebo.

Main Methods:

  • Systematic search of MEDLINE, EMBASE, and CENTRAL databases up to March 2024.
  • Inclusion of randomized controlled trials (RCTs) of intravenous ketamine versus placebo in children.
  • Exclusion of observational studies, case reports, and editorial letters.

Main Results:

  • Seventeen RCTs involving 1,515 patients were analyzed.
  • Ketamine significantly reduced emergence agitation (OR=0.27) and postoperative pain scores (MD=-2.28).
  • No significant differences were found for postoperative nausea, vomiting, desaturation, or laryngospasm.

Conclusions:

  • Ketamine shows potential benefits in reducing emergence agitation and pain in pediatric surgical patients.
  • High heterogeneity and low certainty of evidence limit current recommendations for routine use.
  • High-quality RCTs are required to establish definitive guidelines for ketamine's role in pediatric anesthesia.
Abstract

Keywords:
Emergence agitationEmergence deliriumKetamineMeta-analysisPainSystematic review

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