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Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery.

Khattab AM, El-Seify ZA - Saudi J Anaesth (2009)

Bottom Line: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups.Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups.Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

View Article: PubMed Central - PubMed

Affiliation: Ain Shams University, Cairo, Egypt, Doha Clinic Hospital, Department of Anesthesia, Doha, Qatar.

ABSTRACT

Background and objectives: The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation.

Materials and methods: Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 mug/ kg. The time of hospital discharge allowance was recorded.

Results: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05).

Conclusion: Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

No MeSH data available.


Related in: MedlinePlus

Comparison between both groups with regard to postoperative fentanyl consumption
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Figure 0002: Comparison between both groups with regard to postoperative fentanyl consumption

Mentions: Time to eye opening, agitation scoring, postoperative fentanyl consumption, and time of hospital discharge allowance are shown in Table 5. Time to eye opening was similar in both groups. On admission to the PACU, 37% (17 out of 46, with 10 of them matching score 5) of the children in group M, developed signs and symptoms of agitation that necessitated giving a rescue dose(s) of fentanyl, in comparison to the agitated children within group KM of 11% (Five out of 46 with three of them matching score 5) P < 0.01 [Figure 2]. Fentanyl was given once to all agitated children within group KM, while three of the agitated children in group M needed a second rescue fentanyl dose. Total fentanyl consumption within group M was significantly higher in comparison to group KM (5.08 ± 9.6 vs. 2.021 ± 5.97) P < 0.01.


Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery.

Khattab AM, El-Seify ZA - Saudi J Anaesth (2009)

Comparison between both groups with regard to postoperative fentanyl consumption
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2876942&req=5

Figure 0002: Comparison between both groups with regard to postoperative fentanyl consumption
Mentions: Time to eye opening, agitation scoring, postoperative fentanyl consumption, and time of hospital discharge allowance are shown in Table 5. Time to eye opening was similar in both groups. On admission to the PACU, 37% (17 out of 46, with 10 of them matching score 5) of the children in group M, developed signs and symptoms of agitation that necessitated giving a rescue dose(s) of fentanyl, in comparison to the agitated children within group KM of 11% (Five out of 46 with three of them matching score 5) P < 0.01 [Figure 2]. Fentanyl was given once to all agitated children within group KM, while three of the agitated children in group M needed a second rescue fentanyl dose. Total fentanyl consumption within group M was significantly higher in comparison to group KM (5.08 ± 9.6 vs. 2.021 ± 5.97) P < 0.01.

Bottom Line: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups.Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups.Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

View Article: PubMed Central - PubMed

Affiliation: Ain Shams University, Cairo, Egypt, Doha Clinic Hospital, Department of Anesthesia, Doha, Qatar.

ABSTRACT

Background and objectives: The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation.

Materials and methods: Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 mug/ kg. The time of hospital discharge allowance was recorded.

Results: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05).

Conclusion: Adding a low dose of oral ketamine to midazolam-based oral premedication in preschool children undergoing dental surgery reduced sevoflurane-related emergence agitation without delaying discharge.

No MeSH data available.


Related in: MedlinePlus