The Effect of intravenous Ketamine Versus Thiopental in the Preoperative Holding Area on the Separation Anxiety and Emergence Agitation in Children
International Journal of Anesthesia and Clinical Medicine
Volume 2, Issue 2, March 2014, Pages: 13-17
Received: Mar. 24, 2014;
Accepted: Apr. 14, 2014;
Published: Apr. 30, 2014
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Hye Young Kim, Department of Anesthesiology and Pain Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
Won Sang Lee, Department of Anesthesiology and Pain Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
Won Jun Seo, Department of Anesthesiology and Pain Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
Kyu Chang Lee, Department of Anesthesiology and Pain Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
Background: Pre-anesthetic medication is often required in children to provide anxiolysis and to lessen the psychological impact of hospitalization and procedures. In this study, we compared the effects of intravenous ketamine versus thiopental on the separation anxiety and emergence agitation in children undergoing tonsillectomy/adenoidectomy. Methods: Eighty-two children aged 2-8 years scheduled for adenotonsillectomy were enrolled in this prospective double-blind, randomized study. The children were divided into two groups to receive either intravenous ketamine 1 mg/kg (Group K) or thiopental sodium 3 mg/kg (Group T) to facilitate separation from their parents in the preoperative holding area. Anesthesia was induced using 5 mg/kg thiopental sodium in group K and 2 mg/kg in group T, and was maintained using sevoflurane. The separation anxiety score, emergence agitation score, time from stopping the anesthetics to eye opening, extubation time, and postoperative nausea and vomiting were assessed. Results: There were no significant differences between groups K and T in the preoperative separation anxiety score, emergence agitation score and postoperative nausea and vomiting. However, time to eye opening from stopping the anesthetics and extubation time were significantly delayed in group K compared with group T. Conclusions: Intravenous ketamine or thiopental in the preoperative holding area are equally effective decreasing anxiety upon separation from parents and may not affect incidence of emergence agitation. The administration of thiopental used to induce anesthesia appears to be a better choice for preanesthetic medication with careful monitoring.
Hye Young Kim,
Won Sang Lee,
Won Jun Seo,
Kyu Chang Lee,
The Effect of intravenous Ketamine Versus Thiopental in the Preoperative Holding Area on the Separation Anxiety and Emergence Agitation in Children, International Journal of Anesthesia and Clinical Medicine.
Vol. 2, No. 2,
2014, pp. 13-17.
Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996 Dec;150(12):1238-45.
Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg. 1999 May;88(5):1042-7.
McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg. 2001 Jul;93(1):98-105.
Cole JW, Murray DJ, McAllister JD, Hirshberg GE. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr Anaesth. 2002 Jun;12(5):442-7.
Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997 Dec;87(6):1298-300.
Dong YX, Meng LX, Wang Y, Zhang JJ, Zhao GY, Ma CH. The effect of remifentanil on the incidence of agitation on emergence from sevoflurane anaesthesia in children undergoing adenotonsillectomy. Anaesth Intensive Care. 2010 Jul;38(4):718-22.
Aono J, Furuno K, Ueda W, Manabe M. ICG-disappearance rate during sevoflurane- or neurolept anesthesia. Masui. 1994 Jun;43(6):894-7.
Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia. 1997 Oct;52(10):970-6.
Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004 Dec;99(6):1648-54.
Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiol Scand. 1999 May;43(5):542-4.
Caumo W, Broenstrub JC, Fialho L, Petry SM, Brathwait O, Bandeira D, et al. Risk factors for postoperative anxiety in children. Acta Anaesthesiol Scand. 2000 Aug;44(7):782-9.
Chernow B, Alexander HR, Smallridge RC, Thompson WR, Cook D, Beardsley D, et al. Hormonal responses to graded surgical stress. Arch Intern Med. 1987 Jul;147(7):1273-8.
Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990 Aug;73(2):308-27.
Deshpande S, Platt MP, Aynsley-Green A. Patterns of the metabolic and endocrine stress response to surgery and medical illness in infancy and childhood. Crit Care Med. 1993 Sep;21(9 Suppl):S359-61.
Campbell C, Hosey MT, McHugh S. Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial. Paediatr Anaesth. 2005 Oct;15(10):831-8.
Patel A, Schieble T, Davidson M, Tran MC, Schoenberg C, Delphin E, et al. Distraction with a hand-held video game reduces pediatric preoperative anxiety. Paediatr Anaesth. 2006 Oct;16(10):1019-27.
Vagnoli L, Caprilli S, Robiglio A, Messeri A. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics. 2005 Oct;116(4):e563-7.
Kain ZN, Wang SM, Mayes LC, Krivutza DM, Teague BA. Sensory stimuli and anxiety in children undergoing surgery: a randomized, controlled trial. Anesth Analg. 2001 Apr;92(4):897-903.
Kain ZN, Caldwell-Andrews AA, Krivutza DM, Weinberg ME, Gaal D, Wang SM, et al. Interactive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial. Anesth Analg. 2004 May;98(5):1260-6.
Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg. 1997 Feb;84(2):427-32.
Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med. 2000 Mar 30;342(13):938-45.
Filatov SM, Baer GA, Rorarius MG, Oikkonen M. Efficacy and safety of premedication with oral ketamine for day-case adenoidectomy compared with rectal diazepam/diclofenac and EMLA. Acta Anaesthesiol Scand. 2000 Jan;44(1):118-24.
Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med. 1998 Jun;31(6):688-97.
Butterworth JF WJ. Morgan & Mikhail's Clinical Anesthesilogy. 5th ed. New York, McGraw-Hill, 2013.
Deutsch ES. Tonsillectomy and adenoidectomy. Changing indications. Pediatr Clin North Am. 1996 Dec;43(6):1319-38.
Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitment. A clinical survey. Anesthesiology. 1961 Sep-Oct;22:667-73.
Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. 2007 Jan;104(1):84-91.
Sherwin TS, Green SM, Khan A, Chapman DS, Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000 Mar;35(3):229-38.
Kwak HJ, Kim JY, Kim JH, Kim YS, Park SY. The Effect of Ketamine and Fentanyl on the Incidence of Emergence Agitation after Sevoflurane Anesthesia in Children undergoing Tonsillectomy. Korean J Anesthesiol. 2005; 49(4): 502-6.
Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth. 1995 Mar;42(3):201-3.