Comparing the Effect of Ketamine and Fentanyl in Emergence Agitation under Sevoflurane Anesthesia in Tonsillectomy

Aims: Emergence agitation is an acute confusion state during recovery from anesthesia, a common side effect of sevoflurane anesthesia. Small doses of ketamine or fentanyl appear to decrease the incidence and severity of emergency agitation. The effect of IV ketamine and IV fentanyl on the emergence agitation score in patients undergoing tonsillectomy with or without adenoidectomy under sevoflurane general anesthesia was compared. Materials Methods: Sixty patients in this study are divided randomly into three groups, each comprising 20 patients. So, the first group received IV ketamine, the second group received IV fentanyl, and the third group, the control group, received nothing. Children who were selected were prepared to undergo tonsillectomy with or without adenoidectomy under sevoflurane general anesthesia. Patients were monitored by standard monitoring techniques and mechanically ventilated until the end of the surgery, where they were extubated and transported to the Post Anesthesia Care Unit, where the incidence of emergency delirium was assessed using the Pediatric Anesthesia Emergence Delirium scale. Findings: Emergence delirium was significantly lower in patients receiving ketamine and fentanyl than in the control group (p=0.001). No significant correlation was found between the Pediatric Anesthesia Emergence Delirium score and other variables among both studied groups, indicating that ketamine and fentanyl had a good ameliorating effect of reducing the incidence of emergence delirium. Conclusion: The intravenous administration of either ketamine or fentanyl before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of postoperative agitation.