The Effect of Low Dose Nalbuphine or Ketamine in the Prevention of Emergence Agitation after Sevoflurane Anesthesia in Children Undergoing Tonsillectomy with or without Adenoidectomy

Abstract Background Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment with controversial results. Patients and Methods Totally, 90 children between 4 and 10 years of age and of American Society of Anesthesiologists I-II undergoing adenotonsillectomy under sevoflurane-based anesthesia were enrolled in the study. Children were randomly allocated to one of the three groups: group N received nalbuphine 0.1 mg/kg, group K received ketamine 0.25 mg /kg and group S received the equivalent volume saline. The study medications will be given after discontinuation of sevoflurane by the end of surgery. In the post anesthesia care unit EA was assessed with emergence agitation scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25) and 30 min (T30). Results In the PACU, the incidence of EA (emergence agitation scale) were significantly lower in the N Group (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S group compared to K group and N group (p- value 0.011), more patients experienced postoperative pain (mCHEOPS) in S group compared to N group and K group ( p-value 0.001). Conclusion Nalbuphine 0.1 mg/kg or ketamine 0.25 mg/kg are effective in preventing emergence agitation following sevoflurane-anesthetized adenotonsillectomy paediatric patients.