The Impact of Intranasal Esketamine on Emergence Agitation in Children Undergoing Adenotonsillectomy: A Randomized Controlled Study.
Drug design, development and therapy – January 01, 2025
Source: PubMed
Summary
Many children experience distress, or emergence agitation, waking from anesthesia. A study explored if intranasal esketamine could ease this for children undergoing adenotonsillectomy. Researchers found that a 0.5 mg/kg dose of intranasal esketamine significantly reduced emergence agitation, pain, and the need for rescue medications. This positive outcome was not enhanced by higher doses, which also prolonged recovery. Thus, 0.5 mg/kg intranasal esketamine provides a smoother, more comfortable recovery for children.
Abstract
To investigate the efficacy of intranasal esketamine in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing adenotonsillectomy and to determine the optimal dose of esketamine. A total of 204 children aged 3-6 years scheduled for adenotonsillectomy were randomly assigned to three groups. All participants received a standardized anesthetic induction protocol. Following tracheal intubation, they were administered intranasally 0.5 mg/kg esketamine (group LE), 1 mg/kg esketamine (group HE), or an equivalent volume of saline (group C). Anesthesia was maintained with sevoflurane during surgery, and the children were transferred to the post-anesthesia care unit (PACU) after extubation. The highest scores on the Pediatric Anesthesia Emergence Delirium (PAED) scale and the modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) in the PACU were recorded. The incidence of EA, defined as PAED ≥ 10, was calculated for each group. Additionally, changes in vital signs after intranasal administration, surgery time, anesthesia time, extubation time, eye-opening time, recovery time, and the incidence of adverse reactions were compared among the three groups. Group LE demonstrated a significantly lower incidence of EA compared with group C (10.45% vs 29.85%, P = 0.005), while no significant difference was observed between group LE and HE (10.45% vs 12.12%, P = 0.760). Relative to Group C, children in Group LE also showed significantly lower PAED (P = 0.010) and m-CHEOPS scores (P = 0.023), along with reduced requirements for rescue propofol (P = 0.005) and rescue fentanyl (P = 0.013). Groups LE and HE demonstrated comparable performance across these secondary outcomes; however, extubation time was prolonged in Group HE (P = 0.025). Intranasal esketamine at a dose of 0.5 mg/kg significantly reduces the incidence of EA following pediatric adenotonsillectomy. Increasing the dose to 1 mg/kg does not confer additional benefit in preventing EA and may instead delay extubation.