The Effect of Ketamine and Fentanyl on the Incidence of Emergence Agitation after Sevoflurane Anesthesia in Children undergoing Tonsillectomy

Background: Sevoflurane anesthesia is associated with emergence agitation in children. This study examined the effect of a single intraoperative dose of ketamine and fentanyl on emergence agitation in children undergoing an adenotonsillectomy. Methods: Ninety children, 3-10 years old, undergoing an adenotonsillectomy were enrolled in this study. The patients were randomly assigned to receive either normal saline (control group), ketamine 1 mg/kg (group K), or fentanyl 1/kg (group F) after inducing anesthesia. Ketorolac 0.5 mg/kg was used for postoperative analgesia, and the anesthesia was maintained with sevoflurane. The recovery characteristics, including the time to extubation, the discharge time from the PACU, agitation, pain, and vomiting were assessed. Results: There were no significant differences between the three groups regarding the time to extubation and discharge from the PACU. The incidence of emergence agitation in the control group, group K, and group F was 46.7%, 13.3%, and 33.3%, respectively. The incidence of emergence agitation and the pain score were significantly lower in group K than in the control group (P ＜ 0.05). The incidence of vomiting was similar in the three groups. Conclusions: Children undergoing tonsillectomy with sevoflurane and 1 mg/kg of ketamine given after induction had a reduced incidence of emergence agitation without a delay in recovery. However 1/kg of fentanyl had no effect on the incidence of emergence agitation.