Ketamine for emergence agitation in children

What is it about?

Emergence agitation in children after surgery and procedure is distressing to parents, care-givers and nurses, which may impose risk of self-injury such as accidental removal of catheters or peripheral line and falling out of bed. This meta-analysis demonstrates the potential role of ketamine to prevent emergence agitation in children undergoing surgery or procedure. Its use is well tolerated without any notable adverse effects, namely incidence of postoperative nausea and vomiting, desaturation and laryngospasm.

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Why is it important?

Thirteen studies (1,125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odd ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison to the placebo, ketamine group achieved a lower postoperative pain score (odd ratio -2.42, 95% confidence interval -4.23 to -0.62, certainty of evidence: very low) and lower paediatric anaesthesia emergence delirium scale at 5-minute after operation (odd ratio -3.99, 95% confidence interval -5.03 to -2.95; certainty of evidence: moderate). However, no evidence was observed in term of incidence of postoperative nausea and vomiting, desaturation and laryngospasm.

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