Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial

Abitağaoğlu, Süheyla; Köksal, Ceren; Alagöz, Sevgi; Karip, Ceren Şanlı; Arı, Dilek Erdoğan

doi:10.1016/j.bjane.2020.12.027

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…This difference may be attributed to the type of nasal surgery, certain risk factors, or the absence of a specific scale for evaluating postoperative agitation in each study. The efficacy of ketamine in EA prevention after nasal surgery has been investigated, and Abitağaoğlu et al [ 13 ] reported that the intravenous administration of ketamine after anesthesia induction did not affect the incidence of EA in adults who underwent septoplasty surgeries and delayed the response to verbal stimuli. Demir and Yuzkat [ 9 ] reported that the effect of ketamine intravenously administered 20 minutes before the end of surgery on 140 patients who underwent rhinoplasty showed that ketamine reduced the incidence of EA at subanesthetic doses but prolonged the duration of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial

Almajali

Dalo

Al-Soud

et al. 2023

Anesthesiology Research and Practice

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This study investigates the effect of intramuscular ketamine on emergence agitation (EA) following septoplasty and open septorhinoplasty (OSRP) when administered at subanesthetic doses at the end of surgery. A random sample of 160 ASA I-II adult patients who underwent septoplasty or OSRP between May and October, 2022, was divided into two groups of eighty patients each: ketamine (Group K) and saline (Group S) with the latter serving as the control group. At the end of surgery immediately after turning off the inhalational agent, Group K was administered with intramuscular 2 ml of normal saline containing 0.7 mg/kg ketamine and Group S with 2 ml of intramuscular normal saline. Sedation and agitation scores at emergence from anesthesia were recorded after extubation using the Richmond Agitation-Sedation Scale (RASS). The incidence of EA was higher in the saline group than in the ketamine group (56.3% vs. 5%; odds ratio (OR): 0.033; 95% confidence interval (CI): 0.010–0.103; p < 0.001 ). Variables associated with a higher incidence of agitation were ASA II classification (OR: 3.286; 95% (CI): 1.359–7.944; p = 0.008 ), longer duration of surgery (OR: 1.010; 95% CI: 1.001–1.020; p = 0.031 ), and OSRP surgery (OR: 2.157; CI: 1.056–5.999; p = 0.037 ). The study concluded that the administration of intramuscular ketamine at a dose of 0.7 mg/kg at the end of surgery effectively reduced the incidence of EA in septoplasty and OSRP surgery.

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Section: Discussionmentioning

confidence: 99%

Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial

Almajali

Dalo

Al-Soud

et al. 2023

Anesthesiology Research and Practice

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“…The changes of HR, MAP, and SpO 2 in the effective and ineffective groups were recorded at the following time points: 5 min after entering the room (T0), 1 min before propofol administration (T1), 1 min after propofol administration (T2), 3 min after the administration of propofol (T3), and 5 min after recovery (T4). The mean esketamine dose, VRS score of propofol injection pain, surgical duration, emergence time, visual analog scale (VAS) score of postoperative uterine contraction pain [ 15 ], and Riker sedation/anxiety scale (SAS) score [ 16 ] were recorded. The occurrence of adverse reactions was recorded, including allergic reaction, hypotension, bradycardia, respiratory depression (SpO 2 < 90%), delayed emergence, nausea and vomiting, and postoperative agitation.…”

Section: Methodsmentioning

confidence: 99%

Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon’s up-and-down method: a double-blind, prospective clinical study of drug dose response

et al. 2022

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Background Propofol is an intravenous (IV) anesthetic medication widely used for procedural sedation, operative anesthesia, and in intensive care unit (ICU), but the incidence of pain during IV infusion can reach 28–90%. Ketamine can attenuate pain associated with IV propofol injection through local and central analgesic effects. Ketamine is gradually being transitioned to its S-enantiomer, esketamine, which has a similar mechanism of action. The purpose of our study is to determine the half effective dose (ED50), 95% effective dose (ED95), and 99% effective dose (ED99) of esketamine for attenuating propofol injection pain using Dixon’s up-and-down method to provide a reference for optimal dose selection for surgeries and procedures. Methods Thirty gynecological patients undergoing hysteroscopic surgery were enrolled in a sequential method to determine the effective dose of esticketamine for analgesic propofol injection in order of operation. This study was based on the sequential allocation up-and-down rule designed by Dixon, and each patient was induced by esticketamine combined with propofol. During induction, the target dose of esketamine was first given via venous access in the left hand of the patient, and 30 s later, a fixed dose of 2 mg/kg (1 ml/s) of propofol was given. Patient perception of pain was scored with the verbal rating scale (VRS) every 5 s after the start of the propofol infusion, and the evaluation was stopped once the patient became unresponsive. The dosage of esketamine was increased or decreased up or down according to the patient’s pain response. The initial dose of esketamine was 0.2 mg/kg, and the gradient of adjacent dose was 0.02 mg/kg. If the pain response assessment of the upper patient was positive (+), the dose of esselketamine in the next patient was increased by 0.02 mg/kg; if the pain response assessment of the upper patient was negative (−), the dose of esselketamine in the next patient was decreased by 0.02 mg/kg. The tests were carried out sequentially, with the pain response changing from positive to negative or from negative to positive, and the tests were stopped after at least 6 crossover points, and the effective dose of esticketamine was calculated using probit probability regression analysis. Results The ineffective group comprised patients with a positive pain response and the effective group comprised patients with a negative pain response. The 95% CI was set as the confidence interval of effective dose ED value，and we found esketamine’s ED50 = 0.143 mg/kg (0.120, 0.162 mg/kg), ED95 = 0.176 mg/kg (0.159, 0.320 mg/kg), and ED99 = 0.189 mg/kg (0.167, 0.394 mg/kg). The esketamine dose and VRS score during propofol injection were significantly different between the two groups (P < 0.05), whereas surgical duration, emergence time, visual analogue scale (VAS) score of postoperative uterine contraction pain, and Riker sedation/anxiety scale (SAS) score were not significantly different. Bradycardia occurred in only one patient during anesthesia induction, while hemodynamics was stable in the rest of the patients without obvious adverse reactions. Conclusion Small doses of esketamine combined with propofol can be safely and effectively used for hysteroscopic surgery. We recommended a dose of 0.2 mg/kg IV esketamine before induction of anesthesia to reduce the pain of propofol injection. Trial registration Chinese Clinical Trial Registry ChiCTR2100048951. Date of registration: July 19, 2021.

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Risk of esketamine anesthesia on the emergence delirium in preschool children after minor surgery: a prospective observational clinical study

Chen

Yang

Zhang

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial

Cited by 5 publications

References 17 publications

Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial

Intramuscular Ketamine Effect on Postnasal Surgery Agitation: A Prospective Double-Blinded Randomized Controlled Trial

Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon’s up-and-down method: a double-blind, prospective clinical study of drug dose response

Risk of esketamine anesthesia on the emergence delirium in preschool children after minor surgery: a prospective observational clinical study

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