Archives of Anesthesiology and Critical Care 2015. 1(1):13-17.

Comparing the Effects of Propofol-Ketamine and Sevoflurane-Ketamine on Emergence Delirium and Pain after General Anesthesia in Pediatric Patients Undergoing Interventional Cardiac Angiography
Alireza Ebrahim Soltani, Banafshe Nouralishahi, Hossein Sadrossadat, Mehrdad Goudarzi, Hadi Tabatabaei, Behrang Nooralishahi

Abstract


Background: Emergence delirium (ED) is a frequent postoperative complication in children. Its prevalence is about 25-80% and is observed more commonly with rapid-acting volatile anesthetics than the older inhalation agents.

Methods: 30 patients aging between 2 to 8 years were included in this randomized double blind study. We compared the effect of combination of two anesthetic drugs, Propofol-Ketamine and Sevoflurane- Ketamine, on ED and pain after general anesthesia in pediatric patients undergoing interventional cardiac angiography. Agitation was measured by PAED (Pediatric Anesthesia Emergence Delirium) scoring system) and pain by the CHEOPS (Children’s Hospital of Eastern Ontario Scale).

Results: Emergence delirium in 10th minute of recovery was higher in propofol group (7.6±4.47 vs 5.07±3.31, p=0.047) but it was the same between the groups during the rest of recovery times. Pain scores were higher only at the moment of entrance to recovery room in sevoflurane group (6.27±1.99 vs 5.1±1.06, p<0.001). Mean recovery time was shorter in the sevoflurane group than in the propofol group (33.83±15.239 vs 51.67±20.585, p=0.02).  Nausea and vomitting was more frequent in the sevoflurane group (6.6% vs 0%, p, 0.001), which needed no treatment.

Conclusion: There are some minor differences between sevoflurane-ketamine and propofol-ketamine anesthesia. If the length of recovery is not an issue and the patients are not at high risk of nausea and vomiting, either sevoflurane-ketamine combined anesthesia or propofol-ketamine infusion can be suitably used to anesthetise patients for the pediatric cardiac catheterization procedures.


Keywords


Ketamine; Propofol; Sevoflurane; Ketofol; Pediatric cardiac catheterization; emergence delirium

Full Text:

PDF

References


Bastron RD, Moyers J. Emergence delirium. JAMA. 1967; 200(10):883.

SMESSAERT A, SCHEHR CA, ARTUSIO JF Jr. Observations in the immediate postanaesthesia period. II. Mode of recovery. Br J Anaesth. 1960; 32:181-5.

ECKENHOFF JE, KNEALE DH, DRIPPS RD. The incidence and etiology of postanesthetic excitment. A clinical survey. Anesthesiology. 1961; 22:667-73.

LindJ. Mason. Pitfalls of Pediatric Anesthesia.

Wong DD, Bailey CR. Emergence delirium in children. Anaesthesia. 2015; 70(4):383-7.

Daoud A, Duff JP, Joffe AR Diagnostic accuracy of delirium diagnosis in pediatric intensive care: a systematic review. Crit Care. 2014; 18(5):489.

Galinkin JL, Fazi LM, Cuy RM, Chiavacci RM, Kurth CD, Shah UK, et al. Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology. 2000; 93(6):1378-83.

Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: A comparison with halothane. Paediatr Anaesth. 2000; 10(4):419-24.

Meyer-Pahoulis E, Williams SL, Davidson SI, McVey JR, Mazurek A. The pediatric patient in the post anesthesia care unit. Nurs Clin North Am. 1993; 28(3):519-30.

Haynes C. Emergence delirium: A literature review. Br J Theatre Nurs. 1999; 9(11):502-3, 506-10.

Pieters BJ, Penn E, Nicklaus P, Bruegger D, Mehta B, Weatherly R. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. PediatricAnesthesia. 2010; 20(10):944-950.

Aouad MT, Yazbeck-Karam VG, Nasr VG, El-Khatib MF, Kanazi GE, Bleik JH. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology. 2007; 107(5):733-8.

Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane genral anesthesia. Paediatr Anaesth. 2008; 18(1):55-9.

Shukry M, Clyde MC, Kalarickal PL, Ramadhyani U. Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth. 2005; 15(12):1098-104.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.