Effects of fentanyl and midazolam on emergence agitation following ketamine anesthesia in children

ABSTRACT

BACKGROUND: Recently, a high incidence of emergence agitation (EA) has been reported in children after sevoflurane or desflurane anesthesia. However, in case of ketamine, there are few up-to-date studies about EA in children. This study observed effects of fentanyl and midazolam on emergence agitation and the recovery profile following ketamine anesthesia for outpatient surgery in preschool children. METHODS: Seventy-five children, aged 1-7 years, undergoing brief procedure under intravenous ketamine anesthesia were randomly allocated one of three groups; saline-ketamine, fentanyl-ketamine, midazolam-ketamine. Patients were premedicated with normal saline or fentanyl 0.5microg/kg or midazolam 0.05 mg/kg 5 min before administration of ketamine. Ketamine was given in an initial dose of 1.5 mg/kg and additional dose of 0.5 mg/kg ketamine was given as needed during operative procedure. The incidence of EA and other adverse effects and stay time at recovery room and day surgery center (DSC) were noted. RESULTS: The incidence of emergence agitation was 20 % in control group, 12 % in fentanyl group, and 16 % in midazolam group. Most common adverse effects during recovery was vomiting. There were no significant differences in incidence of emergence agitation, adverse effects and stay time at recovery room and DSC among the three groups. CONCLUSIONS: In children undergoing brief outpatient surgery with ketamine anesthesia, emergence agitation was not significantly reduced by addition of fentanyl 0.5microg/kg or midazolam 0.05 mg/kg. No significant differences were observed among the three groups with respect to adverse effects and recovery profile.