Effect of ketamine versus thiopental sodium anesthetic induction and a small dose of fentanyl on emergence agitation after sevoflurane anesthesia in children undergoing brief ophthalmic surgery

Abstract

BackgroundEmergence agitation (EA) in children after sevoflurane anesthesia is common. The purpose of this study was to compare the incidences of EA between ketamine and thiopental sodium induction in children underwent sevoflurane anesthesia. We also evaluated if a small dose of fentanyl could reduce the incidence of EA.MethodsThe patients who were scheduled for strabismus or entropion surgery were divided into 4 groups. The patients in Groups 1 and 2 were induced anesthesia with ketamine 1.5 mg/kg; those in Groups 3 and 4 were induced with thiopental sodium 5 mg/kg. The patients in Groups 1 and 3 received an injection of fentanyl 1.5 µg/kg, whereas the patients in Groups 2 and 4 received IV saline of the same volume. Anesthesia was maintained with sevoflurane. The recovery characteristics and EA in recovery room were assessed.ResultsThe incidence of EA was significantly higher in Groups 2 and 4 and there was no difference between Groups 2 and 4. Group 2 had almost an eleven-fold higher risk of developing EA than did Group 1, and the incidence of EA in Group 4 was sixty-nine-fold higher than that of Group 1. The risk factor for EA was only the kind of medication. Preoperative anxiety had no significant correlation with EA.ConclusionsThe incidence of EA after sevoflurane anesthesia is similar between ketamine and thiopental sodium anesthetic induction in children undergoing pediatric ophthalmic surgery. Also, the addition of a small dose of fentanyl after anesthetic induction decreases the incidence of EA.

Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients

“…Thus, repeated assessments in this study revealed a higher incidence of EA in the ketamine group despite the slower awakening. A study comparing the incidence of EA in children after short sevoflurane anesthesia with induction of 5 mg/kg thiopental and 1.5 mg/kg of ketamine showed no difference [11]. The incidence of EA in the study was comparable to our results, suggesting anesthetic induction with standard dose of ketamine is not suitable for reducing EA.…”

Effects of Fentanyl on Emergence Agitation in Children under Sevoflurane Anesthesia: Meta-Analysis of Randomized Controlled Trials

“…For the trials that compared a control group with multiple intervention groups using different fentanyl doses, we combined the intervention groups to conduct a single pair-wise comparison. Single fentanyl administration was performed in 15 trials [ 4 , 12 , 43 – 47 , 49 – 56 ], and continuous infusion was carried out in 1 trial [ 48 ]. Five studies were performed in the USA [ 12 , 46 , 53 – 55 ], three in Egypt [ 43 , 47 , 56 ], two each in Korea [ 44 , 49 ] and Turkey [ 50 , 52 ], and one each in Italy [ 4 ], China [ 45 ], Japan [ 48 ] and Saudi Arabia [ 51 ].…”

“…The blinding of participants and personnel, the blinding of the outcome assessment, the presence of incomplete outcome data, and selective reporting were determined to be at a low risk of bias in all included studies. Random sequence generation was unclear in five trials [ 45 , 47 , 49 , 51 , 53 ], and allocation concealment was unclear in 14 studies [ 4 , 12 , 43 , 44 , 46 , 48 – 55 ].…”

Effect of ketorolac on the prevention of emergence agitation in children after sevoflurane anesthesia

“…However, pain can be difficult to assess in preverbal children and may mimic the signs of EA, making it difficult to differentiate EA from postoperative pain. Although intravenous [10,25] or intranasal fentanyl [9] and dexmedetomidine [26,27] are effective in treating both pain and EA, the exact role of pain in the etiology of EA remains unclear. Although ketamine, fentanyl, and dexmedetomidine are known medications in preventing EA, a subgroup analysis of preoperative analgesia found that their analgesic effects had no influence on the efficacy of the drugs on EA [23].…”