Impact of intraoperative intravenous administration of ketamine, fentanyl or propofol in decreasing pediatric posttonsillectomy emergence agitation

To evaluate the frequency of emergence agitation after tonsillectomy in children administeredketamine, fentanyl or propofol during surgery.Our prospective and double-blind investigation included 273 children patients, of both sexes,aged 3-11 years, classed I by the American society of anesthesiologists and scheduled fortonsillectomy under general endotracheal anesthesia at Queen Rania hospital for children,KHMC, Amman, Jordan during the period April 2012-April 2013.Children patients received intravenous induction of anesthesia using fentanyl 2mcg/kg,propofol 2 mg/kg and tracurium 0.5mg/kg ,after which a proper endotracheal tube sizewas secured through which a mixture of nitrous oxide/oxygen with 1 MAC of isoflurane wasdelivered.At the end of surgical procedure, patients received in a random fashion an intravenousdose of either ketamine 1mg/kg(GI,n=93), fentanyl 1 mcg/kg(GII,n=89) or propofol1mg/kg(GIII,n=91).Incidence and intensity of postoperative emergence agitation was assessedusing the five-step emergence agitation scale where; 1 meant obtunded with no response tostimulation, 2 meant asleep but responsive to movement or stimulation, 3 meant awake andresponsive, 4 meant crying and 5 meant thrashing behavior that requires restraint. The patientscale of more or equal to 4 was considered as having emergence agitation. The frequency ofemergence agitation was analyzed statistically using Chi-square test .Significant P –value wasconsidered significant if it was <0.05.Postoperative emergence agitation was 4.4% in propofol group,5.6% in fentanyl group(P> 0.05)and 13.97% in ketamine group (P<0.05).The incidence of postoperative emergence agitation was significantly less in groups usingintraoperative fentanyl or propofol compared to group using ketamine .

Impact of intraoperative intravenous administration of ketamine, fentanyl or propofol in decreasing pediatric posttonsillectomy emergence agitation Keywords:

Intra:operative , venous:fentanyl , ketamine , propofol , isoflurane , paediatric , post-tonsillectomy:emergence agitation