Emergence agitation in children: A comparison of effect of intravenous midazolam and ketamine

Abstract

Background- Emergence agitation (EA) is one of the most challenging conditions to manage in pediatric patients undergoing general anesthesia with sevoflurane as it can even lead to physical harm. Various pharmacological interventions are being used in anesthesia to manage this condition. So, the objective of this study is to compare the effects of intravenous midazolam and intravenous ketamine given as premedication, on the incidence and severity of EA and to assess parent separation anxiety and postoperative pain and analgesic requirement in the 2 groups. Methodology- This is a randomized control trial consisting of 70 children aged 3-7years, 35 in each midazolam and ketamine group that received 0.05mg/kg of i.v. inj. midazolam and 1mg/kg of i.v. inj. ketamine respectively, undergoing general anesthesia with sevoflurane. Emotional status of the child assessed and then allocated into either group through a computer-generated programme. A blinded anesthesiologist assessed the incidence and severity of emergence agitation based on WATCHA scale and Children and Infant Postoperative Pain Scale (CHIPPS). Results- The mean WATCHA and CHIPPS scores were lower in ketamine group at all timepoints versus midazolam group (p<0.05 which is statistically significant).