The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia

Abstract

BackgroundEmergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery.MethodsSixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of the 3 groups: group C received normal saline, group K1.0 received ketamine 1.0 mg/kg intravenously before entering the operating room, or group K0.5 received ketamine 0.5 mg/kg 10 min before the end of the surgery. Before induction, the separation anxiety score was evaluated. Extubation time, post-anesthesia care unit stay time, postoperative nausea and vomiting, emergence agitation, and pain were assessed.ResultsThe group K1.0 had a lower separation anxiety score compared with groups K0.5 and C. Extubation time in group K0.5 was significantly prolonged compared with groups K1.0 and C. The incidence of EA and the modified Children's Hospital of Eastern Ontario Pain Scale were significantly lower in group K1.0 and group K0.5 compared to group C, but there was no significant difference between groups K1.0 and K0.5.ConclusionsIn children undergoing brief ophthalmic surgery with desflurane anesthesia, ketamine 1.0 mg/kg administered before entering the operating room reduced separation anxiety, postoperative pain, and incidence of EA without delay in recovery.

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

“… 26 Administration of 1 mg/kg ketamine prior to entering the operating room was shown to decrease separation anxiety, degree of postoperative pain, and the incidence of EA following paediatric ophthalmic surgery under desflurane anaesthesia. 20 In contrast, low-dose ketamine (0.5 mg/kg) had no effect on postoperative pain, additional analgesic requirement, or postoperative nausea and vomiting during painful ophthalmic surgery. 27 Based on these data, we chose to use 0.1 mg/kg midazolam or 1 mg/kg ketamine in our present study.…”

Comparison of Surgical Pleth Index–guided Analgesia with Conventional Analgesia Practices in Children

“…14 The pain score was determined using the modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), 15 which comprises five items including crying, facial, verbal, torso, and leg status that were summed to calculate a final pain score. Emergence agitation was assessed using a 5-point scale (1: sleeping; 2: calm/awake; 3: irritable or crying, but consolable; 4: crying inconsolably; and 5: severely restless/disoriented), and patients scoring 4 or greater were diagnosed with emergence agitation.…”

The effect of ketamine on emergence agitation in children: A systematic review and meta‐analysis

“…Of all, eleven studies used ketamine as a comparator, except for two studies comparing ketamine‐propofol with the control group only receiving propofol. The majority of studies administered 0.25 mg kg −1 of ketamine, with three studies administering 0.5 mg kg −1 and four studies giving 1 mg kg −1 . All the studies gave intravenous ketamine as a bolus dose, except one study which administered a bolus dose of ketamine followed by ketamine infusion throughout the surgery.…”

“…All the studies gave intravenous ketamine as a bolus dose, except one study which administered a bolus dose of ketamine followed by ketamine infusion throughout the surgery. For the purpose of data analysis, the measured outcomes for different dosages of ketamine were combined in three studies . Ten RCTs anesthetized children with sevoflurane, one desflurane, one isoflurane and one with a combination of sevoflurane and propofol.…”

“…For the purpose of data analysis, the measured outcomes for different dosages of ketamine were combined in three studies . Ten RCTs anesthetized children with sevoflurane, one desflurane, one isoflurane and one with a combination of sevoflurane and propofol. In terms of assessment tools for emergence agitation, six RCTs used PAED, five utilized Aono's Four‐point Scale, and two used the Emergence Agitation Scale.…”