Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.027
Brazilian Journal of Anesthesiology
Clinical Research

Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial

Efeito da cetamina na agitação ao despertar após septoplastia: um estudo clínico randomizado

Süheyla Abitağaoğlu, Ceren Köksal, Sevgi Alagöz, Ceren Şanlı Karip, Dilek Erdoğan Arı

Downloads: 1
Views: 114

Abstract

Background and objectives
The risk of Emergence Agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA.

Methods
In this randomized study, a total of 102 ASA I–II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n = 52) and saline (Group-S, n = 50) groups. After anesthesia induction, Group-K was intravenously administered 20 mL of saline containing 1 mg kg−1 ketamine, whereas Group-S was administered 20 mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30 minutes in the recovery unit.

Results
There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points.

Conclusion
Administration of 1 mg kg−1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.

Keywords

Emergence agitation;  General anesthesia;  Ketamine;  Septoplasty

Resumo

Justificativa e objetivos: O risco de agitação ao despertar (EA) é alto em pacientes submetidos à cirurgia nasal. O objetivo do presente estudo foi investigar a incidência de EA em adultos submetidos à septoplastia e o efeito da cetamina na EA. Metodologia: Neste estudo randomizado, um total de 102 pacientes ASA I – II submetidos à septoplastia entre julho de 2018 e abril de 2019 foram divididos em dois grupos: cetamina (Grupo-K, n = 52) e solução salina (Grupo-S, n = 50) grupos. Após a indução da anestesia, o Grupo K recebeu 20 mL de solução salina contendo 1 mg.kg-1 de cetamina por via venosa, enquanto o Grupo S recebeu 20 mL de solução salina. Os escores de sedação e agitação ao despertar da anestesia, incidência de tosse, tempo de despertar e tempo de resposta aos estímulos verbais foram registrados. Os níveis de sedação / agitação e dor foram registrados por 30 minutos na unidade de recuperação. Resultados: Não houve diferença significativa entre os grupos quanto à incidência de EA (Grupo-K: 15,4%, Grupo-S: 24%). A incidência de tosse durante a emergência foi maior no Grupo-S do que no Grupo-K, mas o tempo de resposta aos estímulos verbais e o tempo de despertar foram menores no Grupo-S. Os escores de sedação e agitação foram semelhantes após a cirurgia. Os escores de dor foram maiores no Grupo-S no momento da admissão na unidade de recuperação e foram semelhantes entre os grupos nos outros momentos. Conclusão: A administração de 1 mg.kg-1 de cetamina após a indução da anestesia não afeta a incidência de EA em pacientes submetidos à septoplastia, mas prolonga o surgimento e o tempo de resposta aos estímulos verbais e reduz a incidência de tosse.

Palavras-chave

Agitação ao despertar, Anestesia geral, Cetamina, Septoplastia.

References

1 Y.S. Kim, Y.K. Chae, Y.S. Choi, et al. A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture Korean J Anesthesiol., 63 (2012), pp. 48-53

2 S.J. Lee, S.J. Choi, C.B. In, T.Y. Sung Effects of tramadol on emergence agitation after general anesthesia for nasal surgery: A retrospective cohort study Medicine., 98 (2019), p. e14763

3 C.Y. Demir, N. Yuzkat Prevention of emergence agitation with ketamine in rhinoplasty Aesthetic Plast Surg., 42 (2018), pp. 847-853

4 J.Y. Chen, J.E. Jia, T.J. Liu, M.J. Qin, W.X. Li Comparison of the effects of dexmedetomidine, ketamine, and placebo on emergence agitation after strabismus surgery in children Can J Anaesth., 60 (2013), pp. 385-392

5 I. Abu-Shahwan, K. Chowdary Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia Paediatr Anaesth., 17 (2007), pp. 846-850

6 D. Yu, W. Chai, X. Sun, L. Yao Emergence agitation in adults: risk factors in 2,000 patients Can J Anaesth., 57 (2010), pp. 843-848

7 Y.S. Jee, H.J. You, T.Y. Sung, C.K. Cho Effects of nefopam on emergence agitation after general anesthesia for nasal surgery: A prospective, randomized, and controlled trial Medicine., 96 (2017), p. e8843

8 H.J. Kim, D.K. Kim, H.Y. Kim, J.K. Kim, S.W. Choi Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery Clin Exp Otorhinolaryngol., 8 (2015), pp. 46-51

9 R. Polat, K. Peker, I. Baran, G. Bumin Aydın, Ç. Topçu Gülöksüz, A. Dönmez Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery: A randomized double-blind trial Anaesthesist., 64 (2015), pp. 740-746

10 A. Ozcan, A.G. Kaya, N. Ozcan, et al. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial Rev Bras Anestesiol., 64 (2014), pp. 377-381

11 P. Zanos, R. Moaddel, P.J. Morris, et al. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms Pharmacol Rev., 70 (2018), pp. 621-660

12 Y.S. Lee, W.Y. Kim, J.H. Choi, J.H. Son, J.H. Kim, Y.C. Park The effect of ketamine on the incidence of emergence agitation in children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia Korean J Anesthesiol., 58 (2010), pp. 440-445

13 L. Munk, G. Andersen, A.M. Møller Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences Acta Anaesthesiol Scand., 60 (2016), pp. 1059-1066

14 A.J. Saleh, L. Zhang, S.M. Hadi, W. Ouyang A priming dose of intravenous ketamine-dexmedetomidine suppresses fentanyl-induced coughing: a double-blind, randomized, controlled study Ups J Med Sci., 119 (2014), pp. 333-337

15 G. Guler, R. Aksu, C. Bicer, Z. Tosun, A. Boyacı Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery: A prospective, double-blind, randomized, placebo-controlled study Curr Ther Res Clin Exp., 71 (2010), pp. 289-297

16 M.A. Peltoniemi, N.M. Hagelberg, K.T. Olkkola, T.I. Saari Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy Clin Pharmacokinet., 55 (2016), pp. 1059-1077
 

605e3394a95395183c2da643 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections