Emergence agitation in children after sevoflurane anaesthesia: a comparative evaluation of ketamine and varying doses of fentanyl

Abstract

Introduction:Sevoflurane, inhalational anaesthetic of choice in children, is associated with high incidence of emergence agitation (EA). But that "one drug" which can significantly reduce or prevent EA still eludes us. Thus we aimed at studying the efficacy of intravenous ketamine and varying doses of intravenous fentanyl on postoperative emergence agitation in children receiving sevoflurane anaesthesia. Materials and methods:This prospective, double blind, randomized comparative study was conducted on 114 children, 2-10 years, with ASA physical status I-II. They were undergoing herniotomy under sevoflurane anaesthesia and were randomly divided into Group A receiving ketamine 0.5 mg/kg, Group B fentanyl 2mcg/kg and Group C fentanyl 3mcg/kg at the time of induction. Postoperatively emergence agitation was assessed every 5 min during first 60 min of PACU stay using Aono's four point scale. We also observed recovery characteristics including time to extubation, time to emergence, discharge from PACU and postoperative complications. Results: The incidence of EA was significantly low in Group A (31.6%) and Group C (28.9%) compared to group B (65.8%), with no significant difference between Group A and Group C. Incidence of EA was higher in preschool children. A prolonged PACU stay was observed in all children who developed EA, with lesser duration of PACU stay noted in fentanyl 3 mcg/kg group. Conclusion: Intravenous administration of either ketamine 0.5 mg/kg or fentanyl 3mcg/kg i.v. at the time of induction reduces the incidence of EA effectively when compared with fentanyl 2mcg/kg, without delaying recovery.

Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial

“… 3 , 4 To date, various preventive strategies have been primarily focused on reducing the overall frequency and severity of EA. 5 , 6 There is considerable individual variation in the level of EA. 7 , 8 Thus, the identification of patients at risk of severe EA may help to further optimize individualized prevention strategies.…”