Comparing the use of Preoperative Ketamine or Midazolam or Ketamine versus Oral Dextromethorphan for Reducing Sevoflurane Emergence Agitation among Preschool Children Undergoing Adenotonsillectomy

Abstract

Background: An increased risk of dangerous emergence agitation (EA) has been linked to the use of sevoflurane. This study aims to  compare the the use of preoperative ketamine, midazolam or Oral Dextromethorphan for reducing sevoflurane emergence agitation  among preschool children undergoing adenotonsillectomy.

Methods: This randomized controlled double-blinded study was carried out  at Zagazig University Hospitals on 56 children who were divided into 4 equal groups; 14 patients in each: Group (C): received 10ml oral placebo (clear fluid) 1 hour before the general anesthesia induction. Group (D): Patients received at a dose of 0.5mg/kg 1 hour from oral dextromethorphan before the general anesthesia induction. Group (K): received a dose of 0.5mg/kg 1 hour of oral ketamine before the  general anesthesia induction. Group (M): received a dose of 0.5 mg/kg 1 hour of oral Midazolam before the general anesthesia induction. 

Results: Regarding heart rate (HR); group (K) was significantly highest compared to other groups. (p<0.001). The  postoperative agitation incidence >4 was significantly lowest in the ketamine group in comparison to the other groups (p=0.02). Group M  was found to be significantly lowest in post-operative pain occurrence in comparison to the other groups (p=0.02). Group K was found to  be significantly lowest in the amount of fentanyl consumption in comparison to the other groups (p=0.004).

Conclusion: Ketamine  premedication is more effective for EA prevention among children during the early emergence time after sevoflurane c ompared to  midazolam and dextromethorphan anethesia.