Shin Nakayama, Hajime Furukawa, Hiromune Yanai

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Department of Anesthesiology, Iwaki Kyoritsu General Hospital, Iwaki, Fukushima, Japan.
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Abstract: Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P < 0.05) and showed delayed recovery (32 ± 9 min) as compared with those who received propofol or sevoflurane (22 ± 8 min and 20 ± 7 min, respectively, P < 0.05). The mean peak PAED score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery.

Keywords: Pediatric Anesthesia, Emergence Agitation, Sevoflurane, Propofol, Ketamine

Cite this paper: Nakayama, S. , Furukawa, H. and Yanai, H. (2015) Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients. Open Journal of Anesthesiology, 5, 163-169. doi: 10.4236/ojanes.2015.57029.

References

[1]   Veyckemans, F. (2001) Excitation Phenomena during Sevoflurane Anaesthesia in Children. Current Opinion Anaesthesioyl, 14, 339-343.
http://dx.doi.org/10.1097/00001503-200106000-00010

[2]   Aono, J., Ueda, W., Mamiya, K., Takimoto, E. and Manabe, M. (1997) Greater Incidence of Delirium during Recovery from Sevoflurane Anesthesia in Preschool Boys. Anesthesiology, 87, 1298-1300.
http://dx.doi.org/10.1097/00000542-199712000-00006

[3]   Voepel-Lewis, T., Malviya, S. and Tait, A.R. (2003) A Prospective Cohort Study of Emergence Agitation in the Pediatric Postanesthesia Care Unit. Anesthesia & Analgesia, 96, 1625-1630.
http://dx.doi.org/10.1213/01.ANE.0000062522.21048.61

[4]   Dahmani, S., Stany, I., Brasher, C., Lejeune, C., Bruneau, B., Wood, C., et al. (2010) Pharmacological Prevention of Sevoflurane- and Desflurane-Related Emergence Agitation in Children: A Meta-Analysis of Published Studies. British Journal of Anaesthesia, 104, 216-223.
http://dx.doi.org/10.1093/bja/aep376

[5]   Sikich, N. and Lerman, J. (2004) Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale. Anesthesiology, 100, 1138-1145.
http://dx.doi.org/10.1097/00000542-200405000-00015

[6]   Bajwa, S.A., Costi, D. and Cyna, A.M. (2010) A Comparison of Emergence Delirium Scales Following General Anesthesia in Children. Paediatric Anaesthesia, 20, 704-711.
http://dx.doi.org/10.1111/j.1460-9592.2010.03328.x

[7]   Cravero, J., Surgenor, S. and Whalen, K. (2000) Emergence Agitation in Paediatric Patients after Sevoflurane Anaesthesia and No Surgery: A Comparison with Halothane. Paediatric Anaesthesia, 10, 419-424.
http://dx.doi.org/10.1046/j.1460-9592.2000.00560.x

[8]   Davis, P.J., Greenberg, J.A., Gendelman, M. and Fertal, K. (1999) Recovery Characteristics of Sevoflurane and Halothane in Preschool-Aged Children Undergoing Bilateral Myringotomy and Pressure Equalization Tube Insertion. Anesthesia & Analgesia, 88, 34-38.
http://dx.doi.org/10.1097/00000539-199901000-00007

[9]   Uezono, S., Goto, T., Terui, K., Ichinose, F., Ishguro, Y., Nakata, Y., et al. (2000) Emergence Agitation after Sevoflurane versus Propofol in Pediatric Patients. Anesthesia & Analgesia, 91, 563-566.
http://dx.doi.org/10.1213/00000539-200009000-00012

[10]   Coté, C.J., Lugo, R.A. and Ward, R.M. (2001) Pharmacokinetics and Pharmacology of Drugs in Children. In: Cote, C.J., Todres, I.D., Goudsouzian, N.G. and Ryan, J.F., A Practice of Anesthesia for Infants and Children, 3rd Edition, Saunders, Philadelphia, 121-171.

[11]   Jung, H.J., Kim, J.B., Im, K.S., Oh, S.H. and Lee, J.M. (2010) Effect of Ketamine versus Thiopental Sodium Anesthetic Induction and a Small Dose of Fentanyl on Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Brief Ophthalmic Surgery. Korean Journal of Anesthesiology, 58, 148-152.
http://dx.doi.org/10.4097/kjae.2010.58.2.148

[12]   Krystal, J.H., Karper, L.P., Seibyl, J.P., Freeman, G.K., Delaney, R., Bremner, J.D., et al. (1994) Subanesthetic Effects of the Noncompetitive NMDA Antagonist, Ketamine, in Humans. Psychotomimetic, Perceptual, Cognitive, and Neuroendocrine Responses. Archives General Psychiatry, 51, 199-214.
http://dx.doi.org/10.1001/archpsyc.1994.03950030035004

[13]   Kawaraguchi, Y., Miyamoto, Y., Fukumitsu, K., Taniguchi, A., Hirao, O., Kitamura, S., et al. (2002) The Effect of Ketamine on Reducing Postoperative Agitation after Sevoflurane Anesthesia in Pediatric Strabismus Surgery. Masui, 51, 1343-1348.

[14]   Chen, J.Y., Jia, J.E., Liu, T.J., Qin, M.J. and Li, W.X. (2013) Comparison of the Effects of Dexmedetomidine, Ketamine, and Placebo on Emergence Agitation after Strabismus Surgery in Children. Canadian Journal of Anesthesia, 60, 385-392.
http://dx.doi.org/10.1007/s12630-013-9886-x

[15]   Dalens, B.J., Pinard, A.M., Letourneau, D., Albert, N.T. and Truchon, R.J. (2006) Prevention of Emergence Agitation after Sevoflurane Anesthesia for Pediatric Cerebral Resonance Imaging by Small Doses of Ketamine or Nalbuphine Administered Just before Discontinuing Anesthesia. Anesthesia & Analgesia, 102, 1056-1061.
http://dx.doi.org/10.1213/01.ane.0000200282.38041.1f

[16]   Abu-Shahwan, I. and Chowdary, K. (2007) Ketamine Is Effective in Decreasing the Incidence of Emergence Agitation in Children Undergoing Dental Repair under Sevoflurane General Anesthesia. Paediatric Anaesthesia, 17, 846-850.
http://dx.doi.org/10.1111/j.1460-9592.2007.02298.x

[17]   Cohen, I.T., Finkel, J.C., Hannallah, R.S., Hummer, K.A. and Patel, K.M. (2003) Rapid Emergence Does Not Explain Agitation Following Sevoflurane anaesthesia in Infants and Children: A Comparison with Propofol. Paediatric Anaesthesia, 13, 63-67.
http://dx.doi.org/10.1046/j.1460-9592.2003.00948.x

[18]   OzdemirKol, I., Egilmez, H., Kaygusuz, K., Gursoy, S. and Mimaroglu, C. (2008) Open-Label, Prospective, Randomized Comparison of Propofol and Sevoflurane for Laryngeal Mask Anesthesia for Magnetic Resonance Imaging in Pediatric Patients. Clinical Therapeutics, 30, 175-181.
http://dx.doi.org/10.1016/j.clinthera.2008.01.008

[19]   Patel, D.K., Keeling, P.A., Newman, G.B. and Radford, P. (1998) Induction Dose of Propofol in Children. Anaesthesia, 43, 949-952.
http://dx.doi.org/10.1111/j.1365-2044.1988.tb05659.x

[20]   Murat, I., Billard, V., Vernois, J., Zaouter, M., Marsol, P., Souron, R., et al. (1996) Pharmacokinetics of Propofol after a Single Dose in Children Aged 1 - 3 Years with minor burns. Comparison of Three Data Analysis Approaches. Anesthesiology, 84, 526-532.
http://dx.doi.org/10.1097/00000542-199603000-00006