Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery

Abstract

Background and Objectives:The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation.Materials and Methods:Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 μg/ kg. The time of hospital discharge allowance was recorded.Results:Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05).Conclusion:Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

Retracted publications and their citation in dental literature: A systematic review

“…140 retracted articles out of 180 (77.8%) are still available in full text on respective journal websites, and 15 of these still available articles (10.7%) present no evident watermark clearly indicating the presence of a retraction (Acharya & Mandal, ; Asgary & Eghbal, ; Cuoghi, Sella, & de Mendonça, ; Dionysopoulos, Koliniotou‐Koumpia, Helvatzoglou‐Antoniades, & Kotsanos, ; Ellakwa & El‐Sheikh, ; Gulsahi et al, ; Khattab, El‐Seify, Shaaban, Radojevic, & Jankovic, ; Kurtulmus & Cotert, ; Nayyar, Khan, Bafna, Ahmed, & Chaluvaiah, ; Ni, Lin, Liu, & Xiao, ; Palenik, ; Scotti, Cardelli, Baldissara, & Monaco, ; Sumanth et al, ; Wang et al, ). The abstracts of 157 out of 180 retracted publications (87.2%) are still available on Pubmed, but 8 of these (5.1%) present neither a footnote nor any clear indication of the presence of a retraction notice (Agrawal, Singh, Rashmikant, Singh, & Chand, ; Dumitrescu, Zetu, & Teslaru, ; Ehrlich et al, ; Kumar et al, ; Maté Sánchez de Val et al, ; Rabanal, Bral, & Goldstein, ; Wang et al, ).…”

Comparison of nebulised dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy

“…5,6 Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces a state of sedation, anaesthesia, immobility, analgesia, and amnesia. 7,8 Sedative premedication in children is commonly administered via the oral, rectal, sublingual, and intranasal routes with varying degrees of patient acceptance. 1e8 Inhalation of nebulised drug is an alternative method of administration that is relatively easy to set up, does not require venepuncture, and is associated with high bioavailability of the administered drug.…”

Effects of ketamine and ketamine with midazolam on emergence agitation in children following sevoflurane anesthesia

“…They also reported incidence of severe agitation of 7.1% in group K (on postoperative day 1) whereas no incidence of severe agitation was noted in group KM similar to our study. Similarly, Ahmed M. Khattab, Zeinab A., El-Seify, et al 32 reported an agitation incidence of 37% in group M and 10.9% in group KM. Their use of Ketamine and Midazolam as oral premedication may suggest altered and possibly inconsistent pharmacokinetics and dynamics compared to IV use of the same drugs.…”