Effect of Propofol and Ketofol on Prevention of Sevoflurane Emergence Agitation in Children - ผลของยาโพรโพฟอลและยาคีโตฟอล ต่อการป้องกันอาการกระวนกระวาย หลังฟื้นจากยาดมสลบซีโวฟลูเรนในผู้ปวยเด็ก

Abstract

                 Emergence agitation from sevoflurane anesthesia is a common problem in pediatric patients which can lead to self injury and cause stress to both caregivers and parents. This prospective, double-blind randomized controlled trial aims to compare the effect of propofol and ketofol on the incidence of sevoflurane emergence agitation in children undergoing adenotonsillectomy. Ninety patients (3-9 years), ASA I, were scheduled for elective adenotonsillectomy. They were randomly divided into 3 groups. Group C (control group, n=30) received 10 ml of intravenous normal saline, Group P (propofol group, n =30) received 1 mg/kg of intravenous propofol and group K (ketofol group, n=30) received 0.25 mg/kg of ketamine mixed with 1 mg/kg of propofol 10 minutes before the end of surgery. The intraoperative and postoperative hemodynamics, respiratory variables and complications were recorded as well as the operation time, anesthesia time, awakening time and duration time in recovery room. The emergence agitation were evaluated by Aono’s four-point scale and Pediatric Anesthesia Emergence Delirium (PAED) scale. Satisfaction of parents and caregivers was evaluated with Verbal Numerical Rating Score (VNRS ) before patients discharged from recovery room. It was found that the incidence of sevoflurane emergence agitation was significantly lower in group P and K compared to group C (p=0.02). All the three groups preserved hemodynamic stability (p>0.05). The time for awakening was significantly prolonged in group P and K (p<0.001) but the time to discharged from recovery room were comparable in the three groups and no significant complications occurred. The parents and caregivers’s satisfaction was significantly higher in group P and K (p<0.001). In conclusion, propofol and ketofol could control sevoflurane emergence agitation in children undergoing adenotonsillectomy but the time for awakening was prolonged.

Key words: emergence agitation, propofol, ketofol, sevoflurane, adenotonsillectomy