Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia.
BACKGROUND
Emergence agitation or delirium is a known phenomenon that may occur in children undergoing general anesthesia with inhaled agents. Our aim was to test the hypothesis that the addition of a small dose of ketamine at the end of sevoflurane anesthesia will result in a decrease in the incidence and severity of such phenomenon.


METHODS
We performed a randomized double blind study involving 85 premedicated children 4-7 years old undergoing dental repair. Children were premedicated with acetaminophen and midazolam. Anesthesia was induced and maintained with sevoflurane in N2O/O2. Group K received ketamine 0.25 mg.kg (-1) and Group S received saline. We evaluated recovery characteristics upon awakening and during the first 30 min using the Pediatric Anesthesia Emergence Delirium scale.


RESULTS
Eighty of the 85 enrolled children completed the study. There were 42 children in Group I. Emergence agitation was diagnosed in seven children in the ketamine group (16.6%) and in 13 children in the placebo group (34.2%). There was no difference in time to meet recovery room discharge criteria between the two groups.


CONCLUSIONS
We conclude that the addition of ketamine 0.25 mg.kg(-1) can decrease the incidence of emergence agitation in children after sevoflurane general anesthesia.
Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. iabushahwan@cheo.on.ca
Ibrahim
I
Abu-Shahwan
Khalid
K
Chowdary
D000766:Anesthesia, Dental / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D010147:Pain Measurement / Q000187:drug effects; D011229:Preanesthetic Medication; D011595:Psychomotor Agitation / Q000517:prevention & control* / Q000523:psychology; D000077149:Sevoflurane
D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007649:Ketamine