Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial

Kim, Kyung Mi; Lee, Ki Hwa; Kim, Yong Han; Ko, Myoung Jin; Jung, Jaehoon; Kang, Eunsu

doi:10.1177/0300060515621639

Cited by 32 publications

(27 citation statements)

References 21 publications

(38 reference statements)

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“… 22 reported that thiopental sodium and ketamine used as anesthetic induction agents in children undergoing ophthalmic surgery showed a similar incidence of EA. 22 However, other studies reported that ketamine premedication 23 or intraoperative use of ketamine 24 were effective in preventing EA.…”

Section: Discussionmentioning

confidence: 98%

Sugammadex affects emergence agitation in children undergoing strabismus surgery

et al. 2018

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ObjectiveEmergence agitation (EA) has a multifactorial origin, and the effect of sugammadex on EA has not been established. We investigated the effect of sugammadex on EA incidence and severity.MethodsWe performed a retrospective study of children aged 1 to 13 years who underwent strabismus surgery. Patients received sugammadex or conventional neuromuscular reversal agents. The primary outcome variables were EA incidence and severity. Secondary outcome variables were postoperative fentanyl use, postoperative nausea and vomiting, time from reversal agent administration to extubation, time from the end of surgery to arrival in the post-anesthesia care unit (PACU) and time spent in the PACU. We used propensity score matching to eliminate baseline imbalances.ResultsAge, sex, use of desflurane, and intraoperative fentanyl were significant predictors of agitation severity using a multivariable analysis. Sugammadex did not significantly affect EA in logistic regression and multiple regression analyses. In the propensity-matched analysis, patients in the sugammadex group showed rapid recovery, but there was no difference in the EA incidence or severity.ConclusionSugammadex did not affect EA incidence or severity compared with conventional cholinesterase inhibitors, although it showed a favorable recovery profile in children undergoing strabismus surgery.

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Section: Discussionmentioning

confidence: 98%

Sugammadex affects emergence agitation in children undergoing strabismus surgery

et al. 2018

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“…may decrease the incidence of early EA (first 20 min) more effectively than midazolam 0.1 mg kg À1 i.v. 66 Premedication with ketamine (6 mg kg À1 orally 30 min before induction) has also been effective in decreasing EA from 56 to 18% after desflurane for adenotonsillectomy. 67 Intraoperative ketamine (1 mg kg À1 i.v.…”

Section: Ketaminementioning

confidence: 99%

Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Mason

2017

British Journal of Anaesthesia

173

190

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There remain unanswered questions and implications related to emergence delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still are unable to predict accurately those who are at greatest risk. Emergence delirium should be considered as a ‘vital sign’, which should be followed and documented in every child in the postanaesthesia recovery period. Standardized screening tools should be adopted for paediatric emergence delirium.

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“…Meanwhile, ketamine has been safely used in pediatric anesthesia for over five decades. It effectively decreased the incidence of emergence delirium in previous studies [ 23 , 24 ]. Moreover, it was equally effective as dexmedetomidine in a study after strabismus surgery with sevoflurane [ 25 ].…”

Section: Discussionmentioning

confidence: 82%

Effect of a mother’s recorded voice on emergence from general anesthesia in pediatric patients: study protocol for a randomized controlled trial

Song

Kwak

Kim

2017

Trials

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BackgroundEmergence delirium is a behavioral disturbance after general anesthesia in children and may distress both the patients and the primary caregivers, such as parents and medical staff, looking after the patients. Various medical and emotional interventions have been investigated to reduce emergence delirium; however, none are completely effective. This trial intends to assess whether the mother’s recorded voice can reduce this adverse post-anesthesia event and facilitate arousal from general anesthesia.Methods/designThis is a prospective, double-blind, single-center, parallel-arm, superiority, randomized controlled trial to be conducted in participants aged 2–8 years who are undergoing elective surgery requiring general anesthesia. Participants will be randomly assigned to one of two groups: those who are stimulated to wake up by listening to their mother’s recorded voice (maternal group, n = 33) or a stranger’s voice (stranger group, n = 33) during anesthetic emergence. The primary outcome is the initial emergence delirium score in the post-anesthesia care unit (PACU). The secondary outcomes are hemodynamic parameters, including heart rate and mean blood pressure, the duration of time between the cessation of anesthetics and a BIS level of 60, 70 and 80, eye-opening or purposeful movement time, extubation time, total consumption of analgesics, PACU stay time, emergence delirium and pain scores during the PACU stay.DiscussionThis is the first randomized controlled trial to investigate the effect of a mother’s recorded voice during emergence on the pediatric emergence profile after general anesthesia. It may provide prophylactic treatment options to decrease emergence delirium and enhance arousal from general anesthesia.Trial registrationClicnicalTrials.gov, ID: NCT02955680. Registered on 2 November 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2164-4) contains supplementary material, which is available to authorized users.

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Comparison of effects of intravenous midazolam and ketamine on emergence agitation in children: Randomized controlled trial

Cited by 32 publications

References 21 publications

Sugammadex affects emergence agitation in children undergoing strabismus surgery

Sugammadex affects emergence agitation in children undergoing strabismus surgery

Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Effect of a mother’s recorded voice on emergence from general anesthesia in pediatric patients: study protocol for a randomized controlled trial

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