Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy

Background: Emergence delirium is a challenge in pediatric anesthesiology, with important unanswered questions concerning incidence, causation, diagnosis, treatment, and sequelae. In this review, we will present the recent research with a particular focus placed on treatment and prevention options. Methods: A wide literature search was conducted across MEDLINE and other databases using PubMed, Embase, Ovid, and the Cochrane Library (latest access: 23 November 2020). The collected publications were assessed for relevance. Only randomized controlled trials and observational studies on postoperative emergence delirium in children were included. Exclusion criteria were articles published before 2018, and studies comprising children older than 12 years of age, mental retardation, or chronic diseases. Results: The final number of studies included in this review was 44. Risk factors identified for emergence delirium were volatile inhalation anesthetics, young age, child temperament, preoperative anxiety, male gender, and specific surgical procedures. Preventive and/or intervention measures were pharmacological (e.g. TIVA, α2-adrenergic agonists (particularly dexmedetomidine), ketamine, propofol, midazolam, opioids (fentanyl)) and non-pharmacological measures (e.g. video or tablet distraction, familiarization with the operating environment, use of mother’s voice, visual preconditioning in eye surgery). Conclusion: ED should be considered a “vital sign” and recorded and documented in all children in the PACU. There is an urgent need for future research to fill in missing gaps of knowledge regarding ED. Implementation of a standardized and validated screening tool for ED are high priorities as is the impact of perioperative monitoring of children at risk to prevent ED.

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“…The incidence and severity of ED were measured by PAED score. Interestingly, no statistical difference could be found [48].…”

Section: Ketaminementioning

confidence: 82%

Postoperative emergence delirium in children: a narrative review of recent publications

Grotmol

Nesarajah

Hansen

2021

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“…At present, analgesics and sedatives are mainly used for the treatment of restlessness and pain. Some studies [9] show that some analgesics can relieve the pain after operation, but have the risk of bronchospasm, respiratory depression, nausea and vomiting, and prolong the recovery time. Some studies have shown that children depend heavily on their parents [18].…”

Section: Discussionmentioning

confidence: 99%

“…At present, the main ways to reduce postoperative restlessness and relieve postoperative pain are drug and psychological intervention. But drug treatment can prolong the recovery time and increase the occurrence of adverse reactions after operation [9]. Li Lei [10] used preoperative games to reduce the incidence of postoperative agitation.…”

Section: Introductionmentioning

confidence: 99%

Parental Presence Promoted Children Anesthesia Recovery: A Randomized Controlled Study

Hai¹,

Zhang²,

Liang³

et al. 2020

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Objective: There are few studies about restlessness and awakening of children during recovering from anesthesia accompanied by parents. Only one related study was retrieved in China. The purpose of this study is to investigate the effect of awakening, agitation and pain level in children after tonsillectomy accompanied by their parents. Methods: Children who met the inclusion criteria were randomly divided into experimental group and control group according to coin tossing method. There were 30 cases in the experimental group and 32 in the control group. The control group received routine nursing while the experimental group was given parental presence on the basis of routine nursing. Steward awakening score, Pediatric anesthesia emergence delirium (PAED), Scale and FLACC pain assessment scale were used to evaluate the children when they entered anesthesia recovery room and awaked respectively. Results: There was no significant difference in the scoring of three scales between the two groups when they entered anesthesia recovery room (P > 0.05). There was significant difference in Steward awakening score and PAED scale between the two groups when they came to recovery room (P < 0.05), but there was no significant difference in FLACC pain score between the two groups (P > 0.05). Conclusion: Parental presence can improve the recovery effect and reduce the restlessness of children after operation. Our study suggests that anesthetic children should be accompanied by their parents in the future.

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“…On the other hands, Jalili et al, who compared the effect of propofol and ketofol on emergence delerium in 87 ASA I and II children aged from 3-12 years and underwent adenotonsillectomy, reported no statistically signi cant difference between the two groups regarding HR in the recovery room at 0, 10, and 20 minutes postoperatively. (19) The smoothness of extubation without coughing, laryngospasm and vomiting on the tube was examined in both groups and it was in favor of ketofol group.…”

Section: Discussionmentioning

confidence: 99%

Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

Mahmoud

Botros

Ragab

2020

Preprint

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Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

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Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy

Cited by 15 publications

References 44 publications

Postoperative emergence delirium in children: a narrative review of recent publications

Postoperative emergence delirium in children: a narrative review of recent publications

Parental Presence Promoted Children Anesthesia Recovery: A Randomized Controlled Study

Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

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