Comparison of Intravenous Ketamine and Midazolam Premedication on Emergence Agitation (EA) in Children following Tonsillectomy with or without Adenoidectomy under General Anaesthesia

A. Maruf, Mozaffer Hossain, R. Ershad, S. Nazrina, M. Kamal
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Abstract

Background: Management of emergence agitation (EA) following tonsillectomy with or without adenoidectomy under general anaesthesia in children has been a major challenge for anaesthesiologists.Several medications have been investigated in an attempt to reduce the occurrence and severity of EA. Objectives: The purpose of this study is to determine the effect of premedication with intravenousmidazolam and ketamine on EA following tonsillectomy with or without adenoidectomy under generalanaesthesia in children. Study design: Randomised clinical study. Methods: Sixty children of both sex, American Society of Anaesthesiologists (ASA) physical status I & IIage 5 to 12 years scheduled to undergo elective tonsillectomy with or without adenoidectomy were randomlyassigned into two groups. Patients in group K (n=30) received premedication of intravenous ketamine0.25 mg/kg body weight in 5 ml total volume and in group M (n=30) received premedication 0.1 mg/kgbody weight intravenous midazolam in 5 ml total volume. After completion of surgery patients weretransferred to recovery. Incidences and severity of EA(Paediatric Anaesthesia Emergence Delirium Scale),pain score (Wong-Baker FACES Pain scale) and postoperative nausea and vomiting (PONV) were assessedat admission in the recovery (T0) and in the post anaesthesia care unit (PACU) at 5 min (T5), at 15 min(T15) and at 30 min (T30). Results: Incidences of EA in Group K remained significantly lower than Group M at admission to therecovery and in the PACU at 5 min and 15 min (P<0.05). Severity of EA was significantly lower patientsin Group K than Group M at admission in recovery and in PACU at 5 minute and 15 minute (P<0.05).There were no significant differences in pain scores between two groups. Regarding PONV there was nosignificant difference between two groups. Conclusion: Premedication with ketamine was more effective than midazolam in the prevention of EAfollowing tonsillectomy with or without adenoidectomy in pediatric patients under general anaesthesia. JBSA 2020; 33(2): 55-61
静脉注射氯胺酮与咪达唑仑对全麻下扁桃体切除术后儿童突发性躁动的影响
背景:儿童扁桃体切除术伴或不伴腺样体切除术全麻后出现性躁动(EA)的处理一直是麻醉医师面临的主要挑战。为了减少EA的发生和严重程度,已经研究了几种药物。目的:本研究的目的是确定全麻下儿童扁桃体切除术伴或不伴腺样体切除术后,静脉注射咪唑安定和氯胺酮对EA的影响。研究设计:随机临床研究。方法:择期行扁桃体切除伴或不伴腺样体切除术的儿童60名,年龄5 ~ 12岁,男女均可。K组(n=30)患者在用药前静脉给予氯胺酮0.25 mg/kg体重,总容积5 ml; M组(n=30)患者在用药前静脉给予咪达唑仑0.1 mg/kg体重,总容积5 ml。手术完成后,患者被转移到康复区。在入院后的恢复期(T0)和麻醉后护理病房(PACU)分别于5分钟(T5)、15分钟(T15)和30分钟(T30)对EA(儿科麻醉紧急谵妄量表)、疼痛评分(Wong-Baker FACES疼痛量表)和术后恶心呕吐(PONV)的发生率和严重程度进行评估。结果:K组患儿康复入院时EA发生率显著低于M组,PACU 5 min、15 min发生率显著低于M组(P<0.05)。K组患者入院恢复时EA严重程度显著低于M组,PACU组患者入院5分钟、15分钟EA严重程度显著低于M组(P<0.05)。两组患者的疼痛评分无显著差异。两组间PONV差异无统计学意义。结论:小儿全麻下扁桃体切除伴或不伴腺样体切除术后,术前应用氯胺酮比咪达唑仑更能有效预防e0的发生。JBSA 2020;33 (2): 55 - 61
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