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Clinical Investigations

Emergence agitation in children after sevoflurane anaesthesia: a comparative evaluation of ketamine and varying doses of fentanyl

Authors:

Derlin Thomas,

IN
About Derlin
Postgraduate student, Anaesthesiology, St John's Medical College Hospital, Hosur Road, Bengaluru, Karnataka
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Jui Lagoo ,

St John's Medical College Hospital, Hosur Road, Bengaluru, Karnataka, IN
About Jui
Assistant Professor, Anaesthesiology, St John's Medical College Hospital, Hosur Road, Bengaluru, Karnataka
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Kshma Kilpadi

IN
About Kshma
Professor, Anaesthesiology, St John's Medical College Hospital, Hosur Road, Bengaluru, Karnataka,
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Abstract

Introduction:
Sevoflurane, inhalational anaesthetic of choice in children, is associated with high incidence of emergence agitation (EA). But that “one drug” which can significantly reduce or prevent EA still eludes us. Thus we aimed at studying the efficacy of intravenous ketamine and varying doses of intravenous fentanyl on postoperative emergence agitation in children receiving sevoflurane anaesthesia.

Materials and methods:
This prospective, double blind, randomized comparative study was conducted on 114 children, 2-10 years, with ASA physical status I-II. They were undergoing herniotomy under sevoflurane anaesthesia and were randomly divided into Group A receiving ketamine 0.5 mg/kg, Group B fentanyl 2mcg/kg and Group C fentanyl 3mcg/kg at the time of induction. Postoperatively emergence agitation was assessed every 5 min during first 60 min of PACU stay using Aono's four point scale. We also observed recovery characteristics including time to extubation, time to emergence, discharge from PACU and postoperative complications.

Results: The incidence of EA was significantly low  in Group A (31.6%) and Group C (28.9%) compared to group B (65.8%), with no significant difference  between Group A and Group C. Incidence of  EA was higher in preschool children. A prolonged PACU stay was observed in all children who developed EA, with lesser duration of  PACU stay noted in fentanyl 3 mcg/kg group.

Conclusion: Intravenous administration of either ketamine 0.5 mg/kg or fentanyl 3mcg/kg i.v. at the time of induction reduces the incidence of EA effectively when compared with fentanyl 2mcg/kg, without delaying recovery.

DOI: http://dx.doi.org/10.4038/slja.v23i1.7514

How to Cite: Thomas, D., Lagoo, J. & Kilpadi, K., (2015). Emergence agitation in children after sevoflurane anaesthesia: a comparative evaluation of ketamine and varying doses of fentanyl. Sri Lankan Journal of Anaesthesiology. 23(1), pp.10–16. DOI: http://doi.org/10.4038/slja.v23i1.7514
Published on 11 Jan 2015.
Peer Reviewed

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