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

Hassan, Mahmoud Ahmed Ibrahim; Tawfik, Mohamed Shehta; El Desouky, Maha Ibrahiem; Medhat, Marwa

doi:10.21608/zumj.2023.236189.2889

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

Document Type : Original Article

Authors

¹ Anaesthesia and Surgical intensive care Department, Faculty of Medicine, Zagazig University, Zagazig , Egypt

² Anaesthesia and Surgical intensive care Department, Faculty of Medicine, Zagazig university, Zagazig, Egypt

³ Anesthesia &amp;amp; surgical icu , faculty of medicine , zagazig university , zagazig , al sharqia , egypt

10.21608/zumj.2023.236189.2889

Abstract

Background: An increased risk of dangerous emergence agitation (EA) has been linked to the use of sevoflurane.

Objectives: 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.

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