Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

Özcan, Ayşe; Kaya, Ayse Gunay; Özcan, Namık; Karaaslan, Gul Meltem; Er, Esen; Baltaci, Bülent; Başar, Hülya

doi:10.1016/j.bjane.2014.01.004

Cited by 19 publications

(20 citation statements)

References 27 publications

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“…In other study, Shahwan et al 33 have reported an median PAED score as 7 with IQR (0-19) in Ketamine group which is similar to the incidence in this study. In study by Ozcan et al 34 the median PAED score in group Ketamine was 5 which is consistent with this study. The reported incidence of emergence agitation of around 19% in group Ketamine is higher than the incidence in this study.…”

Section: Gulcan Erk Dilsensupporting

confidence: 92%

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

Sharma¹,

Rana²

2018

J. Soc. Anesth. Nep.

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Background : Emergence agitation is a distressful phenomenon associated with inhalational agents such as Sevoflurane in short surgical procedures. Various drugs have been used in the past but some come at the cost of increased complications. We aim to study the effects of ketamine alone and ketamine with midazolam on emergence agitation and their effects on recovery and discharge times.Methods: We conducted a prospective randomized controlled trial among 94 patients aged two to ten years presenting for ophthalmic surgeries in which 45 patients were allocated to each group: group K (Ketamine) and group KM (Ketamine with Midazolam). Group K received Ketamine 0.3 mg/kg IV and Group KM received Ketamine 0.3 mg/kg IV and Midazolam 0.03 mg/kg IV. Intraoperatively heart rate and post-operatively emergence agitation, recovery times, discharge times were studied.Results: Demographic variables were comparable between the two groups. Median Pediatric Anesthesia Emergence Delirium (PAED) score of 6 with IQR (4-6) in group K was comparable to the median score of 5 with IQR (4-6) in group KM. The mean recovery time of 22}4.82 min in group K was significantly lower compared to the mean time of 25.75}3.32 min in group KM. Mean time to discharge of 67}11 min from the hospital in group K was significantly shorter compared to that in group KM (108}18 mins).Conclusion: We concluded from our study that ketamine alone is as effective as ketamine with midazolam in reducing the emergence agitation following Sevoflurane anesthesia for ophthalmic surgery. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 57-65

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Section: Gulcan Erk Dilsensupporting

confidence: 92%

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

Sharma¹,

Rana²

2018

J. Soc. Anesth. Nep.

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“…Indeed, the present study also showed that patients exhibited a high incidence of 80% of emergence agitation after sevoflurane anesthesia. Postoperative pain is firstly considered to contribute to emergence agitation [22]; however, the severity of postoperative pain after cataract surgery is relative low, and the VAS score is 1 to 2 [23]. Furthermore, in the current study, we used effective topical anesthetic drops and supplementation with intravenous 1 mg/kg of Flurbiprofen Axetil Injection (a kind of nonsteroidal anti-inflammatory drugs; Tidepharm Inc, Beijing, China) to prevent pain, and thus, the postoperative pain after cataract surgery has little effect on emergence agitation in the present study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

Lin

Chen

Huang

et al. 2016

Journal of Clinical Anesthesia

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“…9 However, the 'at risk' age for EA is considered as 3 years or below. 10 This may in part be due to a number of factors such as emotional lability, the trauma of parental separation, recovery in a strange environment, and others. Some studies suggest that EA is more common with short procedures as patients will be wide awake before the peak effect of analgesics has been achieved; others found a higher incidence of EA with longer duration of anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

Pradeep

Manissery

Upadya

2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Emergence agitation (EA) is a well-recognised phenomenon often observed in children following general anaesthesia. The aim of this study was to compare the incidence and severity of EA in the paediatric age group under sevoflurane or isoflurane anaesthesia using the PAED Scale (Pediatric Anaesthesia Emergence Delirium Scale) (the primary outcome) and its correlation with preinduction agitation as well as its association with pain using the FLACC (Face Legs Activity Cry Consolability) score (the secondary outcome). Method: In this randomised controlled trial, 60 children aged between 2 and 6 years were enrolled and randomly divided into two groups. All patients were induced with sevoflurane, relaxed with atracurium and the airway secured with an appropriate device. Anaesthesia was maintained with O 2 , N 2 O and sevoflurane or isoflurane. Adequate analgesia was ensured. Post-procedure, they were observed in the post-anaesthesia care unit (PACU) for development of EA. The statistical package SPSS® version 17 was used and data were analysed using Student's unpaired t-test and a chi-square test. Statistical significance was accepted at p < 0.05. Results: The mean PAED scale was 12.9 in the sevoflurane group and 9.4 in the isoflurane group (p < 0.001). The incidence of EA was significantly related to preinduction agitation (p = 0.00). Higher FLACC scores were observed only within the initial 10 min in the sevoflurane group (p = 0.009). Conclusions: An increased incidence of EA was observed with sevoflurane maintenance anaesthesia, particularly during the initial 10-20 min of the postoperative period. EA was strongly associated with preinduction agitation, but it was poorly correlated to pain, i.e. not all patients who developed EA had a high FLACC score.

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Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

Cited by 19 publications

References 27 publications

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

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

Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane

Emergence agitation in paediatric patients using sevoflurane and isoflurane anaesthesia: a randomised controlled study

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