Abstract
BackgroundEmergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy.MethodsThis study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients’ entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.ResultsAt the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008).ConclusionThe ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.
Highlights
Emergence agitation (EA) in children is one of the most common early complications after anaesthesia, manifesting with behavioral symptoms such as restlessness, disorientation, excitation, impulsive movements and crying
This study was a randomised, doubleblind clinical trial conducted on 150 children undergoing adenotonsillectomy surgery at the Khalili and Dastgheib hospitals affiliated to the Shiraz University of Medical Sciences (Shiraz, Iran) from June to November 2018
Based on the post-hoc test, a difference in Richmond agitation-sedation scale (RASS) was found among all groups at baseline and 5 min after surgery; the ketamine-propofol group varied significantly in this index from the other two groups 10 min and 20 min after surgery
Summary
Emergence agitation (EA) in children is one of the most common early complications after anaesthesia, manifesting with behavioral symptoms such as restlessness, disorientation, excitation, impulsive movements and crying. Various factors play a role in the occurrence of EA, such as post-operative pain, reduced effect of anaesthesia drugs in recovery, type of drug and anaesthesia technique, type and location of surgery, age, stress during induction of anaesthesia, hypoxemia, airway. One of the most common surgical procedures in children is adenotonsillectomy, which is associated with post-operative pain and bleeding. EA is very common in otolaryngology procedures, increasing the rate of post-operative airway obstruction and its complications. Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketaminemidazolam and ketamine-propofol on EA after tonsillectomy
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