Effect of Fentanyl versus Ketamine on the Incidence of Emergence Delirium from Sevoflurane Anaesthesia in Pediatric Patients
Abstract
Devyani Dineshchandra Solanki, Saumil H Shah* and Tanmay Prasad
Background: Emergence delirium (ED) is a transient confusional state occurring during recovery from general anesthesia, characterized by agitation, crying, restlessness, and disorientation. It is more commonly seen in pediatric patients, particularly following the use of inhalational anesthetics such as sevoflurane. Although ED is usually self-limiting, it can lead to complications such as self-injury, disruption of surgical sites, increased stress for caregivers, and the need for additional monitoring in the post-anesthesia care unit (PACU). Various pharmacological agents including opioids and dissociative anesthetics have been investigated to reduce the incidence of ED.
Aim: To compare the efficacy of intravenous fentanyl (1 μg/kg) and ketamine (0.5 mg/kg) administered 10 minutes before the end of surgery in preventing emergence delirium in pediatric patients undergoing general anesthesia with sevoflurane.
Materials and Methods: This prospective observational study included 60 pediatric patients aged 5–12 years undergoing elective surgeries under general anesthesia. Patients were randomly divided into two groups of 30 each. Group F received intravenous fentanyl 1 μg/kg, while Group K received intravenous ketamine 0.5 mg/kg, administered 10 minutes before completion of surgery. Standard general anesthesia was induced with propofol and maintained with oxygen, nitrous oxide, and sevoflurane. Emergence delirium was assessed using Aono’s four-point scale at 5, 10, 20, and 30 minutes postoperatively. Postoperative pain was evaluated using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS), and recovery was assessed using the Modified Aldrete Score. Statistical analysis was performed using independent sample t-test and chi-square test with a p-value <0.05 considered statistically significant.
Results: Demographic characteristics and intraoperative hemodynamic parameters were comparable between the two groups. The incidence of emergence delirium was significantly higher in the ketamine group compared to the fentanyl group. At 5 minutes postoperatively, ED was observed in 63.33% of patients in the ketamine group compared to 16.66% in the fentanyl group. Pain scores measured using CHEOPS were also higher in the ketamine group. Emergence time and extubation time were slightly prolonged in the ketamine group, although both groups maintained stable hemodynamic parameters and showed minimal adverse effects.
Conclusion: Intravenous fentanyl 1 μg/kg administered 10 minutes before the end of surgery is more effective than ketamine 0.5 mg/kg in reducing the incidence of emergence delirium in pediatric patients undergoing sevoflurane anesthesia. Fentanyl also provides better postoperative analgesia with a comparable safety profile.