Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children

Fattahi-Saravi, Zeinabsadat; Jouybar, Reza; Haghighat, Rezvan; Asmarian, Naeimehossadat

doi:10.21315/mjms2021.28.5.7

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…It does not cause respiratory depression at small doses (< 1 mg/kg), and has little effect on the heart rate and blood pressure (Jahangir et al, 1993). Various studies have demonstrated that ketamine at sub-anesthetic doses (0.25 mg/kg-0.5 mg/kg) is highly effective in preventing ED (Abu-Shahwan and Chowdary, 2007;Demir and Yuzkat, 2018;Fattahi-Saravi et al, 2021). The most commonly used ketamine in the clinic is a racemic mixture of two optical isomers, levo-ketamine (R-ketamine) and dextro-ketamine (S-ketamine).…”

Section: Discussionmentioning

confidence: 99%

Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy

Chen

Ru²,

Ye³

et al. 2023

Front. Pharmacol.

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Background: S-ketamine (the S-isomer of ketamine) is twice as potent as the racemic mixture of this agent and carries fewer side effects when administered to humans. Information regarding the use of S-ketamine for the prevention of emergence delirium (ED) is limited. Thus, we evaluated the effect of S-ketamine administered at the end of anesthesia on ED in preschool children undergoing tonsillectomy and/or adenoidectomy.Methods: We investigated 108 children aged 3–7 years, who were scheduled for elective tonsillectomy and/or adenoidectomy under general anesthesia. They were randomly assigned to receive either S-ketamine 0.2 mg/kg or an equal volume of normal saline at the end of anesthesia. The primary outcome was the highest score on the pediatric anesthesia ED (PAED) scale during the first 30 min post-surgery. The secondary outcomes included the incidence of ED (defined as a score of ≥ 3 on Aono scale), pain score, time to extubation, and incidences of adverse events. Multivariate analyses were also performed using logistic regression to evaluate the independent factors predictive of ED.Results: The median (interquartile range) PAED score of the S-ketamine group (0 [0, 3]) was significantly lower than that in the control group (1 [0, 7]) (estimate median difference = 0, 95% confidence interval −2 to 0, p = 0.040). Significantly fewer patients in the S-ketamine group had an Aono scale score ≥ 3 (4 [7%] vs. 12 [22%], p = 0.030). Patients in the S-ketamine group also had a lower median pain score than did control subjects (4 [4, 6] vs. 6 [5, 8], p = 0.002). The time to extubation and incidences of adverse events were comparable between the two groups. However, multivariate analyses indicated that except S-ketamine use, pain scores, age and duration of anesthesia were independent factors predictive of ED.Conclusion: S-ketamine (0.2 mg/kg) administered at the end of anesthesia effectively reduced the incidence and severity of ED in preschool children undergoing tonsillectomy and/or adenoidectomy without prolonging the time to extubation or increasing adverse events. However, S-ketamine use was not an independent factor predictive of ED.

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Section: Discussionmentioning

confidence: 99%

Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy

Chen

Ru²,

Ye³

et al. 2023

Front. Pharmacol.

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“…Based on Ramsey's sedation score, a study by Adiban et al revealed that KM resulted in better sedation at all times (5, 10, 30, and 60 minutes post-administration) [18], but in another study, KM was better than KP only at the 35 th minute [10]. Fattahi-Saravi et al showed that KP recipients had lower scores on the Richmond Agitation-Sedation Scale [21]. In another study, where the level of sedation was based on the Observer Assessment of Alertness and Sedation Scale, there was no difference between the two compounds [17].…”

Section: Discussionmentioning

confidence: 99%

A comparison of the effects of Ketamine-Midazolam and Ketamine-Propofol combinations on vital signs of uncooperative children with dental diseases in a crossover study with repeated measurements: The Bayesian approach

Abbasi-Asl

Zayeri

Ghasemi

et al. 2023

Preprint

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Background: To calm non-cooperative children needing dental treatment, sedatives are used. Vital parameters must be monitored during sedation. This study aimed to evaluate the effects of Ketamine-Midazolam (KM) and Ketamine-Propofol (KP) combinations on the heart rate (HR) and oxygen saturation (SPO2) of uncooperative children. The model parameters were estimated using the Bayesian approach. Methods: The data were collected in a double-blind crossover study with repeated measurements (CSWRM). Twenty-two 3-6-year-old uncooperative children were included, and the linear mixed model was adopted for data analysis. Results: A significant difference of 4.47 beats per minute (bpm) was found in the mean HR of KM recipients compared to KP recipients. The mean HR in KP was lower than that of KM, but it did not make a difference in SPO2. Conclusions: Although there was no difference in the two drug combinations regarding SPO2, they differed in HR. As such, the KP combination is recommended. The study was registered in the Iranian Registry of Clinical Trials (IRCT20090506001882N10) at the date of 2021-03-08.

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“…Emergence agitation is a well-known phenomenon in children after general anesthesia, ( Mohkamkar et al, 2014 ; Cao et al, 2016 ), especially in those undergoing adenotonsillectomy. ( Fattahi-Saravi et al, 2021 ). The incidence of emergence agitation varies from 0.25% to 90.5%.…”

Section: Introductionmentioning

confidence: 99%

Low-dose esketamine for the prevention of emergency agitation in children after tonsillectomy: A randomized controlled study

Fan

Zhang

2022

Front. Pharmacol.

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Background: Emergency agitation is a common postoperative complication in pediatric patients after general anesthesia. The aim of this study was to explore the effects of a low dose of esketamine on emergency agitation in children following tonsillectomy.Materials and Methods: Eighty children were recruited prospectively to this study and divided into the esketamine group and the control group (40 cases in each group). The induction and maintenance of anesthesia were the same in both groups. At the end of surgery, the esketamine group received 0.25 μg/kg esketamine, while the control group received the same volume of normal saline. The extubation time, time to eye opening, Ramsay sedation scale and time to discharge from the post-anesthesia care unit (PACU) were recorded during post-anesthesia care unit. Postoperative complications, such as emergency agitation, respiratory depression, hypertension, tachycardia, nightmares, nausea, and vomiting, were also recorded.Results: The incidence of emergency agitation was lower in the esketamine group compared with that in the control group (5% vs. 27.5%, p = 0.006). The time to eye opening was longer in the esketamine group than in the control group (17.2 ± 2.7 vs. 15.5 ± 2.3 min, p = 0.005). However, the extubation time and time to discharge from PACU were similar between the two groups.Conclusion: Low-dose of esketamine decreases the incidence of emergency agitation in children after tonsillectomy without delaying extubation time and increasing the postoperative side effects. (www.chictr.org.cn, registration number: ChiCTR2100054178).

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Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children

Cited by 5 publications

References 32 publications

Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy

Effect of S-ketamine administered at the end of anesthesia on emergence delirium in preschool children undergoing tonsillectomy and/or adenoidectomy

A comparison of the effects of Ketamine-Midazolam and Ketamine-Propofol combinations on vital signs of uncooperative children with dental diseases in a crossover study with repeated measurements: The Bayesian approach

Low-dose esketamine for the prevention of emergency agitation in children after tonsillectomy: A randomized controlled study

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