JMERC
Owner
Janbazan Medical and Engineering Research Center (JMERC) is the owner of IJWPH.
0.4
Cite Score
SJR: 0.114 / SNIP: 0.090
Volume 15, Issue 4 (2023)
Iran J War Public Health 2023, 15(4): 421-428 |
Back to browse issues page
Article Type:
Subject:
History
Received: 2023/07/5 | Accepted: 2024/01/18 | Published: 2024/01/28
Received: 2023/07/5 | Accepted: 2024/01/18 | Published: 2024/01/28
How to cite this article
Saeed Z, Jaafar J, Najim R. Comparing the Effect of Ketamine and Fentanyl in Emergence Agitation under Sevoflurane Anesthesia in Tonsillectomy. Iran J War Public Health 2023; 15 (4) :421-428
URL: http://ijwph.ir/article-1-1368-en.html
URL: http://ijwph.ir/article-1-1368-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rights and permissions
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
1- Faculty of Pharmacy, University of Kufa, Kufa, Iraq
2- Faculty of Medicine, University of Kufa, Kufa, Iraq
3- Ministry of Health, Al-Sadar Teaching Hospital, Kufa, Iraq
2- Faculty of Medicine, University of Kufa, Kufa, Iraq
3- Ministry of Health, Al-Sadar Teaching Hospital, Kufa, Iraq
Abstract (617 Views)
Aims: Emergence agitation is an acute confusion state during recovery from anesthesia, a common side effect of sevoflurane anesthesia. Small doses of ketamine or fentanyl appear to decrease the incidence and severity of emergency agitation. The effect of IV ketamine and IV fentanyl on the emergence agitation score in patients undergoing tonsillectomy with or without adenoidectomy under sevoflurane general anesthesia was compared.
Materials & Methods: Sixty patients in this study are divided randomly into three groups, each comprising 20 patients. So, the first group received IV ketamine, the second group received IV fentanyl, and the third group, the control group, received nothing. Children who were selected were prepared to undergo tonsillectomy with or without adenoidectomy under sevoflurane general anesthesia. Patients were monitored by standard monitoring techniques and mechanically ventilated until the end of the surgery, where they were extubated and transported to the Post Anesthesia Care Unit, where the incidence of emergency delirium was assessed using the Pediatric Anesthesia Emergence Delirium scale.
Findings: Emergence delirium was significantly lower in patients receiving ketamine and fentanyl than in the control group (p=0.001). No significant correlation was found between the Pediatric Anesthesia Emergence Delirium score and other variables among both studied groups, indicating that ketamine and fentanyl had a good ameliorating effect of reducing the incidence of emergence delirium.
Conclusion: The intravenous administration of either ketamine or fentanyl before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of postoperative agitation.
Materials & Methods: Sixty patients in this study are divided randomly into three groups, each comprising 20 patients. So, the first group received IV ketamine, the second group received IV fentanyl, and the third group, the control group, received nothing. Children who were selected were prepared to undergo tonsillectomy with or without adenoidectomy under sevoflurane general anesthesia. Patients were monitored by standard monitoring techniques and mechanically ventilated until the end of the surgery, where they were extubated and transported to the Post Anesthesia Care Unit, where the incidence of emergency delirium was assessed using the Pediatric Anesthesia Emergence Delirium scale.
Findings: Emergence delirium was significantly lower in patients receiving ketamine and fentanyl than in the control group (p=0.001). No significant correlation was found between the Pediatric Anesthesia Emergence Delirium score and other variables among both studied groups, indicating that ketamine and fentanyl had a good ameliorating effect of reducing the incidence of emergence delirium.
Conclusion: The intravenous administration of either ketamine or fentanyl before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of postoperative agitation.
References
1. Munk L, Andersen G, Møller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anesthesia Scans 2016;60:1059-66. [Link] [DOI:10.1111/aas.12717]
2. Dahmani S, Delivet H, Hilly J. Emergence delirium in children: an update. Curr Opin Anaesthesiol 2014;27(3):309-15. [Link] [DOI:10.1097/ACO.0000000000000076]
3. Lee SJ, Choi SJ, In CB, Sung TY. Effects of tramadol on emergence agitation after general anesthesia for nasal surgery: a retrospective cohort study. Medicine (Baltimore) 2019;98(10):e14763. [Link] [DOI:10.1097/MD.0000000000014763]
4. Jee YS, You HJ, Sung TY, Cho CK. Effects of nefopam on emergence agitation after general anesthesia for nasal surgery: a prospective, randomized, and controlled trial. Medicine (Baltimore) 2017;96(47):e8843. [Link] [DOI:10.1097/MD.0000000000008843]
5. Kuratani N, Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: A meta-analysis of randomized controlled trials. Anesthesiology. 2008;109(2):225-32. [Link] [DOI:10.1097/ALN.0b013e31817f5c18]
6. Uezono S, Goto T, Terui K, Ichinose F, Ishguro Y, Nakata Y, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg. 2000;91(3):563-6. [Link] [DOI:10.1213/00000539-200009000-00012]
7. Kim JH. Mechanism of emergence agitation induced by sevoflurane anesthesia. Korean J Anesthesiol 2011;60(2):73-4. [Link] [DOI:10.4097/kjae.2011.60.2.73]
8. Vlajkovic GP, Sindjelic RP. Emergence delirium in children: Many questions, few answers. Anesth Analg. 2007;104(1):84-91. [Link] [DOI:10.1213/01.ane.0000250914.91881.a8]
9. Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, et al. Pharmacological prevention of sevofluraneand desflurane-related emergence agitation in children: A meta-analysis of published studies. Br J Anaesth. 2010;104(2):216-23. [Link] [DOI:10.1093/bja/aep376]
10. Lerman J. Emergence delirium and agitation in children. Anesthesia Anal. 2017;126(1):365. [Link] [DOI:10.1213/ANE.0000000000002587]
11. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. New York: McGraw-Hill Education; 2015. [Link]
12. Koner O, Ture H, Mercan A, Menda F, Sozubir S. Effects of hydroxyzine-midazolam premedication on sevoflurane-induced paediatric emergence agitation: A prospective randomised clinical trial. Eur J Anaesthesiol. 2011;28(9):640-5. [Link] [DOI:10.1097/EJA.0b013e328344db1a]
13. Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevofluraneanesthesia. Anesthesiology. 2007;107(5):733-8. [Link] [DOI:10.1097/01.anes.0000287009.46896.a7]
14. Kim JY, Chang YJ, Lee JY, Park HY, Kwak HJ. Post-induction alfentanil reduces sevoflurane-associated emergence agitation in children undergoing an adenotonsillectomy. Acta Anaesthesiol Scand. 2009;53(5):678-81. [Link] [DOI:10.1111/j.1399-6576.2009.01943.x]
15. Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth. 2007;17(9):846-50. [Link] [DOI:10.1111/j.1460-9592.2007.02298.x]
16. von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in paediatric anesthesia: a prospective cohort study. Lancet. 2010;376(9743):773-83. [Link] [DOI:10.1016/S0140-6736(10)61193-2]
17. Brouilette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S, et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr. 1984;105(1):10-4. [Link] [DOI:10.1016/S0022-3476(84)80348-0]
18. Leach JOlson JHermann JManning S Polysomnographic and clinical findings in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992;118(7):741-744. [Link] [DOI:10.1001/archotol.1992.01880070071013]
19. Carroll JL. Sleep-related upper-airway obstruction in children and adolescents. Child Adolesc Psychiatr Clin North Am. 1996;5(3):617-47. [Link] [DOI:10.1016/S1056-4993(18)30352-3]
20. Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung. 1981;159(5):275-87. [Link] [DOI:10.1007/BF02713925]
21. Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr. 1982;100(1):31-40. [Link] [DOI:10.1016/S0022-3476(82)80231-X]
22. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100(5):1138-45. [Link] [DOI:10.1097/00000542-200405000-00015]
23. Bajwa SA, Costi D, Cyna AM. A comparison of emergence delirium scales following general anesthesia in children. Paediatr Anaesth. 2010;20(8):704-11. [Link] [DOI:10.1111/j.1460-9592.2010.03328.x]
24. Bryce-Smith R, O'Brien HD. Fluothane: A non-explosive volatile anaesthetic agent. BMJ. 1956;2(4999):969-72. [Link] [DOI:10.1136/bmj.2.4999.969]
25. Johnstone M. The human cardiovascular response to fluothane anesthesia. Br J Anaesth. 1956;28(9):392-410 [Link] [DOI:10.1093/bja/28.9.392]
26. Suckling CW. Some chemical and physical factors in the development of fluothane. Br J Anaesth. 1957;29(10):466-72. [Link] [DOI:10.1093/bja/29.10.466]
27. Morray JP, Geiduschek JM, Ramamoorthy C, Haberkern CM, Hackel A, Caplan RA, et al. Anesthesia-related cardiac arrest in childreninitial findings of the pediatric perioperative cardiac arrest (POCA) registry. Anesthesiol J Am Soc Anesthesiol. 2000;93(1):6-14. [Link] [DOI:10.1097/00000542-200007000-00007]
28. Sarner JB, Levine M, Davis PJ, Lerman J, Cook DR, Motoyama EK. Clinical characteristics of sevoflurane in children. A comparison with halothane. Anesthesiology. 1995;82(1):38-46. [Link] [DOI:10.1097/00000542-199501000-00006]
29. Komatu H. Electrical seizures during sevoflurane anesthesia in two pediatric patients with epilepsy. Anesthesiology. 1994;81(6):1535-7. [Link] [DOI:10.1097/00000542-199412000-00030]
30. Woodforth IJ, Hicks RG, Crawford MR, Stephen JPH, Burke DJ. Electroencephalographic evidence of seizure activity under deep sevoflurane anesthesia in a nonepileptic patient. Anesthesiol J Am Soc Anesthesiol. 1997;87(6):1579-82. [Link] [DOI:10.1097/00000542-199712000-00041]
31. Yasuda N, Lockhart SH, Weiskopf RB, Liu J, Laster M, Taheri S, et al. Comparison of kinetics of sevoflurane and isoflurane in humans. Anesth Analg. 1991;72(3):316-24. [Link] [DOI:10.1213/00000539-199103000-00007]
32. Shiraishi Y, Ikeda K. Uptake and biotransformation of sevof lurane in humans: A comparative study of sevof lurane with halothane, enflurane, and isoflurane. J Clin Anesth. 1990;2(6):381-6. [Link] [DOI:10.1016/0952-8180(90)90024-W]
33. Kharasch ED. Biotransformation of sevoflurane. Anesth Analg. 1995;81(6S):27S-38. [Link] [DOI:10.1097/00000539-199512001-00005]
34. Barash PG, Cullen BF, Stoelting RK, Cahalan MK. Clinical Anesthesia. Philadelphia:Wolters Kluwer; 2017. [Link]
35. Meller ST. Ketamine: Relief from chronic pain through actions at the NMDA receptor?. Pain. 1996;68(2-3):435-6. [Link]
36. Herd DW, Anderson BJ, Keene NA, Holford NHG. Investigating the pharmacodynamics of ketamine in children. Paediatr Anaesth. 2008;18(1):36-42. [Link] [DOI:10.1111/j.1460-9592.2007.02384.x]
37. Dallimore D, Anderson BJ, Short TG, Herd DW. Ketamine anesthesia in children-exploring infusion regimens. Paediatr Anaesth. 2008;18(8):708-14. [Link] [DOI:10.1111/j.1460-9592.2008.02665.x]
38. Anderson BJ, McKee AD, Holford NH. Size, myths and the clinical pharmacokinetics of analgesia in paediatric patients. Clin Pharmacokinet. 1997;33(5):313-27. [Link] [DOI:10.2165/00003088-199733050-00001]
39. Dalens BJ, Pinard AM, Létourneau DR, Albert NT, Truchon RJ. Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia. Anesth Analg. 2006;102(4):1056-61. [Link] [DOI:10.1213/01.ane.0000200282.38041.1f]
40. Lee YS, Kim WY, Choi JH, Son JH, Kim JH, Park YC. The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia. Korean J Anaesthesiol. 2010;58(5):440-5. [Link] [DOI:10.4097/kjae.2010.58.5.440]
41. Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Oral ketamine premedication can prevent emergence agitation in children after desflurane anesthesia. Pediatr Anesth. 2004;14(6):477-82. [Link] [DOI:10.1111/j.1460-9592.2004.01224.x]
42. Khattab AM, El-Seify ZA. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery. Saudi J Anesth. 2009;3(2):61-6. [Link] [DOI:10.4103/1658-354X.57878]
43. Finkel JC, Cohen IT, Hannallah RS, Patel KM, Kim MS, Hummer KA, et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg. 2001;92(5):1164-8. [Link] [DOI:10.1097/00000539-200105000-00016]
44. Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg. 2002;94(5):1178-81. [Link] [DOI:10.1097/00000539-200205000-00023]
45. Silva LMD, Braz LG, Módolo NSP. Emergence agitation in pediatric anesthesia: current features. J Pediatr. 2008;84(2):107-13. [Link] [DOI:10.2223/JPED.1763]
46. Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997;87:1298-300. [Link] [DOI:10.1097/00000542-199712000-00006]
47. Cravero JP, Beach M, Thyr B, Whalen K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg. 2003;97(2):364-7. [Link] [DOI:10.1213/01.ANE.0000070227.78670.43]
48. Alkhaldi RN. Impact of intraoperative intravenous administration of ketamine, fentanyl or propofol in decreasing pediatric post-tonsillectomy emergence agitation. IntJ Med Investigat. 2013;2(3). [Link]
49. Aouad MT, Nasr VG. Emergence agitation in children: An update. Curr Opinion Anesthesiol. 2005;18(6):614-9. [Link] [DOI:10.1097/01.aco.0000188420.84763.35]
50. Sarner JB, Levine M, Davis PJ, Lerman J, Cook DR, Motoyama EK. Clinical characteristics of sevoflurane in children. A comparison with halothane. Anesthesiology. 1995;82:38-46. [Link] [DOI:10.1097/00000542-199501000-00006]
51. Cravero J, Surgenor S, Whalen K. Emergence agitation in pediatric patients after sevoflurane anesthesia and no surgery: A comparison with halothane. Paediatr Anaesth. 2000;10(4):419-24. [Link] [DOI:10.1046/j.1460-9592.2000.00560.x]
52. Costi D, Cyna AM, Ahmed S, Stephens K, Strickland P, Ellwood J, et al. Effects of sevoflurane versus other general anesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;12(9):CD007084. [Link] [DOI:10.1002/14651858.CD007084.pub2]