Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial

Abitağaoğlu, Süheyla; Köksal, Ceren; Alagöz, Sevgi; Karip, Ceren Şanlı; Arı, Dilek Erdoğan

doi:10.1016/j.bjane.2020.12.027

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Brazilian Journal of Anesthesiology

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Sumário

CLINICAL RESEARCH • para Braz. J. Anesthesiol. 71 (4) • Jul-Aug 2021 • https://doi.org/10.1016/j.bjane.2020.12.027 copy

Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives

The risk of emergence agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA.

Methods

In this randomized study, a total of 102 ASA I-II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n = 52) and saline (Group-S, n = 50). After anesthesia induction, Group-K was intravenously administered 20 mL of saline containing 1 mg kg^-1 ketamine, whereas Group-S was administered 20 mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30 minutes in the recovery unit.

Results

There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points.

Conclusion

Administration of 1 mg kg^-1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.

KEYWORDS
Emergence agitation; General anesthesia; Ketamine; Septoplasty

Score	Term	Descriptor
7	Severely agitated	Remove endotracheal tubes, attempt to remove catheters, climb over bedrail, attack staff, thrash sideways
6	Very agitated	Do not calm down despite frequent verbal reminders of limits, require physical restraints, bite endotracheal tubes
5	Agitated	Display anxiety or mild agitated, attempt to sit up, calm down on verbal instructions
4	Calm, cooperative	Calm, easily arousable, follow verbal instructions
3	Sedated	Difficult to arouse, awaken to verbal stimuli or gentle shaking but drifts off again, follow simple verbal instructions
2	Highly sedated	Arouse to physical stimuli but do not communicate or follow verbal instructions, may move spontaneously
1	Unarousable	Minimal or no response to noxious stimuli, do not communicate or follow verbal instructions

	Group K (n = 52)	Group S (n = 50)	p
Age, years (mean ± SD)	33.54 ± 10.71	32.80 ± 10.35	0.724^a a t-test.
Female sex, n (%)	15 (28.8%)	18 (36.0%)	0.440^b b Pearson's Chi-Squared test.
BMI, kg.m^-2 (mean ± SD)	24.33 ± 3.30	24.08 ± 3.58	0.717^a a t-test.
ASA, n (%)			0.422^b b Pearson's Chi-Squared test.
I	41 (78.8%)	36 (72.0%)
II	11 (21.2%)	14 (28.0%)
Surgical duration, minutes (median [min-max])	64.00 (27-210)	55.00 (20-121)	0.136^c c Mann-Whitney U-test, p < 0.05 was considered statistically significant.

		Group K (n = 52)	Group S (n = 50)	p
		n (%)	n (%)	p
Emergence SAS	Agitated	8 (15.4%)	12 (24.0%)	0.273^a a Pearson Chi-Square test.
	Calm/Sedated	44 (84.6%)	38 (76.0%)
Cough incidence	None	41 (78.8%)	26 (52.0%)	0.036^a a Pearson Chi-Square test.
	Present	11 (21.2%)	24 (48.0%)
Emergence time (min)	Mean (SD)	11.79 (4.65)	7.54 (3.21)	<0.001^b b t-test, p < 0.05 was considered statistically significant.
Response to verbal stimuli time (min)	Mean (SD)	13.48 (4.90)	9.22(3.45)	<0.001^b b t-test, p < 0.05 was considered statistically significant.

	Postoperative time (min)		Group K (n = 52)	Group S (n = 50)	p
	Postoperative time (min)		n (%)	n (%)	p
SAS	0	Agitated	0 (0.0%)	1 (2.0%)	0.490^a a Fisher's exact test.
		Calm/Sedated	52 (100%)	49 (98%)
	10	Agitated	0 (0.0%)	0 (0.0%)	-
		Calm/Sedated	52 (100%)	50 (100%)
	20	Agitated	1 (1.9%)	0 (0.0%)	1.000^a a Fisher's exact test.
		Calm/Sedated	51 (98.1%)	50 (100%)
	30	Agitated	1 (1.9%)	0 (0.0%)	1.000^a a Fisher's exact test.
		Calm	51 (98.1%)	50 (100%)
VAS	0	Median (min-max)	0 (0-5)	1 (0-8)	0.001^b b Mann-Whitney U-test, p < 0.05 was considered statistically significant.
	10	Median (min-max)	0 (-1-5)	0 (-2-3)	0.108^b b Mann-Whitney U-test, p < 0.05 was considered statistically significant.
	20	Median (min-max)	0 (-2-6)	0 (-2-5)	0.213^b b Mann-Whitney U-test, p < 0.05 was considered statistically significant.
	30	Median (min-max)	0 (-2-6)	0 (-5-5)	0.181^b b Mann-Whitney U-test, p < 0.05 was considered statistically significant.

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail: suheylaatay81@gmail.com (S. Abitağaoğlu).