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

Abstract

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.

The influence of low-dose s-ketamine on postoperative delirium and cognitive function in older adults undergoing thoracic surgery

“…Their findings indicated that administering S-ketamine (0.2 mg/kg) at the end of anesthesia effectively reduced the incidence and severity of delirium in preschool children undergoing tonsillectomy and/or adenoidectomy. Importantly, this intervention did not prolong extubation time or increase adverse events [18]. The dosage utilized by Yang and colleagues was lower than that employed by Bornemann et al These results suggest that different doses of S-ketamine may lead to distinct pharmacological effects, which may be associated with patient tolerance and sensitivity.…”

Effect of esketamine combined with dexmedetomidine on delirium in sedation for mechanically ventilated ICU patients: protocol for a nested substudy within a randomized controlled trial

“…In general anesthesia, esketamine can reduce the incidence of postoperative delirium and quicken neurocognitive recovery in elderly patients [ 19 , 20 ]. Administered at the end of anesthesia, esketamine can also reduce the incidence of emergence delirium in preschool children [ 21 ]. Nevertheless, clinical trials on the efficacy and safety of esketamine-dexmedetomidine combination remain to be expanded.…”

Recent advances in the study of anesthesia-and analgesia-related mechanisms of S-ketamine

“…S-ketamine can also shorten the recovery time from anesthesia for painless examinations or operations, with lower respiratory and circulatory-related risks ( Yang et al, 2022 ; Xin et al, 2022 ; Yongping et al, 2022 ; Zheng et al, 2022 ). It is equally safe and effective in pediatric patients ( Zhang et al, 2022 ), and S-ketamine may also reduce the incidence of postoperative agitation as well as delirium in children ( Li et al, 2022 ; Zhang et al, 2022 ; Chen et al, 2023 ).…”