Effects of Ketamine and Midazolam on Emergence Agitation after Sevoflurane Anaesthesia in Children Receiving Caudal Block: A Randomized Trial

ABSTRACT

Introduction: Emergence agitation is a common postanaesthetic complication in children after sevofluraneanaesthesia. We aimed to compare the effects of ketamineand midazolam administered intravenously, before the endof surgery, for prevention of emergence agitation in childrenwho received caudal block for pain relief under sevofluraneanaesthesia.Material and Methods: 100 American Society ofAnaesthesiologists status I children aged 4-11 years scheduledfor inguinal hernia repair, circumcision or orchidopexywere enrolled to the study. Anaesthesia was induced withsevoflurane 8% in a mixture of 50% oxygen and nitrous oxide.After adequate depth of anaesthesia, a laryngeal mask wasplaced and caudal block was performed with 0.5 mL kg−1,0.125% bupivacaine. At the end of the surgery, ketamine0.25 mg kg−1 or midazolam 0.03 mg kg− were given to theirrespective groups. Agitation was assessed using PaediatricAnaesthesia Emergence Delirium scale and postoperative painwas evaluated with modified Children's Hospital of EasternOntario Pain Scale.Results and conclusion: modified Children's Hospital ofEastern Ontario Pain Scale scores were found higher inmidazolam group as compared to ketamine group at 0 minutesand 5 minutes while after 10 minutes, the scores becameinsignificant. Paediatric Anaesthesia Emergence Deliriumscores were found to be higher in midazolam group at 0, 5 and10 minutes as compared to ketamine group, but at 30 minutes,the delirium scores became comparable. Thus, ketaminewas able to prevent Emergence Delirium as well as decreasepain scores better than midazolam following sevofluraneanaesthesia in children with caudal block