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The Impact of Intranasal Esketamine on Emergence Agitation in Children Undergoing Adenotonsillectomy: A Randomized
Jiajia Li1,2,3, Gaili Jia1,2,3, Ruixian Wang1,2,3
1Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
Insights
Intranasal esketamine at 0.5 mg/kg effectively reduces emergence agitation (EA) in pediatric patients after adenotonsillectomy. Higher doses do not offer additional benefits and may prolong recovery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Emergence agitation (EA) is a common complication following general anesthesia in pediatric patients.
- Adenotonsillectomy is a frequent surgical procedure in children, often associated with EA.
- Intranasal esketamine is being explored as a potential agent to mitigate EA.
Purpose of the Study:
- To evaluate the efficacy of intranasal esketamine in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing adenotonsillectomy.
- To determine the optimal dosage of intranasal esketamine for preventing EA in this population.
Main Methods:
- A randomized controlled trial involving 204 children aged 3-6 years undergoing adenotonsillectomy.
- Participants were assigned to receive intranasal 0.5 mg/kg esketamine (LE), 1 mg/kg esketamine (HE), or saline (C) post-intubation.
- Incidence of EA (defined as PAED score ≥ 10), PAED scores, m-CHEOPS scores, and recovery parameters were assessed.
Main Results:
- The low-dose esketamine group (LE) showed a significantly lower incidence of EA compared to the control group (10.45% vs. 29.85%, P=0.005).
- No significant difference in EA incidence was found between the low-dose (LE) and high-dose (HE) esketamine groups (10.45% vs. 12.12%, P=0.760).
- Group LE exhibited reduced PAED and m-CHEOPS scores and lower requirements for rescue analgesics compared to controls; however, Group HE experienced prolonged extubation time.
Conclusions:
- Intranasal esketamine at 0.5 mg/kg is effective in significantly reducing emergence agitation following pediatric adenotonsillectomy.
- Increasing the dose to 1 mg/kg does not provide additional benefits for EA prevention and may lead to delayed extubation.
- The 0.5 mg/kg dose represents a potentially optimal strategy for managing EA in this pediatric surgical context.
Purpose:
To investigate the efficacy of intranasal esketamine in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing adenotonsillectomy and to determine the optimal dose of esketamine.
Methods:
A total of 204 children aged 3-6 years scheduled for adenotonsillectomy were randomly assigned to three groups. All participants received a standardized anesthetic induction protocol. Following tracheal intubation, they were administered intranasally 0.5 mg/kg esketamine (group LE), 1 mg/kg esketamine (group HE), or an equivalent volume of saline (group C). Anesthesia was maintained with sevoflurane during surgery, and the children were transferred to the post-anesthesia care unit (PACU) after extubation. The highest scores on the Pediatric Anesthesia Emergence Delirium (PAED) scale and the modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) in the PACU were recorded. The incidence of EA, defined as PAED ≥ 10, was calculated for each group. Additionally, changes in vital signs after intranasal administration, surgery time, anesthesia time, extubation time, eye-opening time, recovery time, and the incidence of adverse reactions were compared among the three groups.
Results:
Group LE demonstrated a significantly lower incidence of EA compared with group C (10.45% vs 29.85%, P = 0.005), while no significant difference was observed between group LE and HE (10.45% vs 12.12%, P = 0.760). Relative to Group C, children in Group LE also showed significantly lower PAED (P = 0.010) and m-CHEOPS scores (P = 0.023), along with reduced requirements for rescue propofol (P = 0.005) and rescue fentanyl (P = 0.013). Groups LE and HE demonstrated comparable performance across these secondary outcomes; however, extubation time was prolonged in Group HE (P = 0.025).
Conclusion:
Intranasal esketamine at a dose of 0.5 mg/kg significantly reduces the incidence of EA following pediatric adenotonsillectomy. Increasing the dose to 1 mg/kg does not confer additional benefit in preventing EA and may instead delay extubation.
