The Effect of Ketamine and Fentanyl on Emergence Agitation after Sevoflurane-Based Anesthesia in Children Undergoing Tonsillectomy with or without Adenoidectomy: A Randomized Blind Comparison Study.

Abstract

Emergence agitation (EA) has many potential etiologies and remains a significant clinical issue in children postoperatively, Adenoidectomy and tonsillectomy are the most common operations done on children, Sevoflurane is the inhalational anaesthetic agent of choice in the pediatric age group, and it has a higher incidence of emergence agitation in children, it reaches up to 80% when used alone. Method:  After obtaining our institutional ethics committee approval and written informed consent from parents, in a prospective, randomized, blind study, we enrolled 80 children 2-10 years old undergoing tonsillectomy with or without adenoidectomy under sevoflurane-based anaesthesia. We assigned children to one of two groups, Group A (n=40) received ketamine 0.5mg/kg, and Group B (n=40) received fentanyl 2mcg/kg intravenously at induction. Anesthesia protocol was standardized for all children, time to extubating, emergence time, duration of surgery, anaesthesia, and post-anaesthetic care unit stay, and incidence of emergence agitation were recorded and compared in both groups, aiming to compare the effect of ketamine and fentanyl on the post-operative EA in children. Results: 80 patients participated in this study, in the fentanyl group 75% of the children had emergency agitation as compared to 20% in the ketamine group (P= 0.000), post anaesthetic care unit stay time was significantly less in the ketamine group, the two groups were comparable in age, sex, durations of surgery, durations of anaesthesia, and time to extubating. Conclusion: in children undergoing tonsillectomy with/without adenoidectomy under sevoflurane-based anaesthesia, administration of intravenous ketamine at induction of anaesthesia significantly reduces the incidence of emergence agitation as compared with fentanyl