Efficacy of ketamine in prevention of agitation in children undergoing magnetic resonance imaging under face mask sevoflurane: A randomized trial

Abstract

Background: Emergence agitation (EA) is a common distressing problem in children after sevoflurane general anesthesia. The aim of the present study was to test the efficacy of ketamine in prevention of EA after sevoflurane general anesthesia in children undergoing magnetic resonance imaging (MRI) scan. Also, we evaluated the safety and efficacy of the face mask for administration of sevoflurane anesthesia in children. Methods: In this randomized study, 120 children aged 2-7 years (ASA I or II) of either sex scheduled for elective MRI scan under sevoflurane anesthesia were enrolled in the study protocol. Patients were randomly allocated to one of 3 groups: saline group receiving normal saline (n = 40), ketamine 0.25 group receiving 0.25 mg/kg of ketamine intravenously 10 min prior the end of the procedure (n = 40), and ketamine 1.0 group receiving 1.0 mg/kg of ketamine intravenously before sevoflurane induction, (n = 40). Anesthesia was provided with sevoflurane in 100% oxygen. EA score, pausing of the scan, scan time, discharge time and any reported adverse events were recorded. Results: No significant differences as regards age, weight, sex, or ASA score were found among the studied groups. Children in ketamine 1.0 group reported significant lower EA score in comparison with ketamine 0.25 and saline groups (P < 0.05). Ketamine 0.25 group reported significant lower EA score in comparison with saline group (P < 0.05). Children in ketamine 1.0 group reported significant lower incidence of pausing in comparison with ketamine 0.25 and saline groups (P < 0.05). No significant differences as regards nausea, vomiting, desaturation, scan and discharge times among the studied groups (P > 0.05) were found. Conclusion: Ketamine premedication was effective in reducing EA without delay in recovery and significantly reduced the incidence of pausing of MRI scan.

The effect of ketamine on emergence agitation in children: A systematic review and meta‐analysis

“…Of all, eleven studies used ketamine as a comparator, except for two studies comparing ketamine‐propofol with the control group only receiving propofol. The majority of studies administered 0.25 mg kg −1 of ketamine, with three studies administering 0.5 mg kg −1 and four studies giving 1 mg kg −1 . All the studies gave intravenous ketamine as a bolus dose, except one study which administered a bolus dose of ketamine followed by ketamine infusion throughout the surgery.…”

“…All the studies gave intravenous ketamine as a bolus dose, except one study which administered a bolus dose of ketamine followed by ketamine infusion throughout the surgery. For the purpose of data analysis, the measured outcomes for different dosages of ketamine were combined in three studies . Ten RCTs anesthetized children with sevoflurane, one desflurane, one isoflurane and one with a combination of sevoflurane and propofol.…”

“…Ten RCTs anesthetized children with sevoflurane, one desflurane, one isoflurane and one with a combination of sevoflurane and propofol. In terms of assessment tools for emergence agitation, six RCTs used PAED, five utilized Aono's Four‐point Scale, and two used the Emergence Agitation Scale.…”

“…The overall risk of bias assessment was low for five studies and unclear for eight studies (Table S4). The highest risk of bias across all included studies was the domain of sequence generation, followed by the allocation concealment and the blinding of outcome assessment.…”

“…Although pain is recognized as one of the most important contributing factors to emergence agitation, the phenomenon of emergence agitation was also seen in children underwent non‐painful procedure such as MRI scan . Apart from pain, preoperative anxiety and rapid emergence following sedation in an unfamiliar environment are among the risk factors of emergence agitation in children .…”