Effect of Ketamine vs. Ketamine-Midazolam vs. Ketamine-Propofol on Post-Tonsillectomy Agitation in Kids

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Zeinabsadat Fattahi-Saravi, Reza Jouybar, Rezvan Haghighat, Naeimehossadat Asmarian


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children

Year: 2021 | Doi: 10.21315/mjms2021.28.5.7

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

Emergence agitation (EA) is a common complication observed in children post-anesthesia, characterized by restlessness, disorientation, and aggressive behaviors. It increases stress for healthcare providers and families, complicates patient monitoring, and can potentially lead to injury or prolonged recovery. Several factors can influence the incidence of EA, including the type of surgical procedure, patient age, and anesthesia protocols. This study aims to compare the effects of three different drug combinations—ketamine, ketamine-propofol, and ketamine-midazolam—on EA in children undergoing adenotonsillectomy.

Effect of Drug Combinations on Emergence Agitation

Among the important findings, the ketamine-midazolam combination showed a significant reduction in the Richmond Agitation-Sedation Scale (RASS) scores at both the time of entry into the post-anesthesia care unit (PACU) and 5 minutes following surgery compared to the ketamine group. Furthermore, the ketamine-propofol group demonstrated lower RASS scores at 10 and 20 minutes after surgery. The Modified Aldrete Recovery Score (MARS) was consistently lower in the ketamine-propofol group at all time points, indicating reduced recovery stability. The overall recovery time from anesthesia was longer for the ketamine-propofol group, raising questions about the advantages of using this combination in the pediatric population.

Conclusion

The study indicates that the ketamine-midazolam combination is associated with lower agitation levels, greater hemodynamic stability, and better recovery scores without delaying awakening, compared to ketamine or ketamine-propofol combinations. These findings suggest that ketamine-midazolam may provide a more effective strategy for managing emergence agitation in children after adenotonsillectomy, emphasizing the need for careful consideration of drug combinations to optimize pediatric anesthesia outcomes. Further research is recommended to explore optimal dosing and the long-term effects of these combinations on recovery and agitation.

FAQ section (important questions/answers):

What is emergence agitation (EA) in children after anesthesia?

Emergence agitation (EA) is a common post-anesthesia complication in children, characterized by behavioral symptoms such as restlessness, disorientation, and excessive crying. It can delay recovery and discharge from the post-anesthesia care unit (PACU) and may increase stress for patients and caregivers.

How was the study on ketamine and midazolam conducted?

The study was a randomized, double-blind clinical trial involving 162 children undergoing adenotonsillectomy. Participants received either ketamine, ketamine-propofol, or ketamine-midazolam before the end of surgery. Outcomes were measured using the Modified Aldrete Recovery Score (MARS) and Richmond Agitation-Sedation Scale (RASS) at specified intervals.

What were the main findings about ketamine-midazolam versus ketamine-propofol?

The ketamine-midazolam combination resulted in lower RASS scores and greater hemodynamic stability compared to ketamine-propofol. However, recovery time was longer for ketamine-propofol. Overall, ketamine-midazolam showed better performance for managing post-operative agitation without delaying awakening.

What implications do these results have for pediatric anesthesia?

The findings suggest that using ketamine-midazolam can effectively reduce EA and stabilize hemodynamic parameters in children post-anesthesia. This could help improve patient outcomes, enhance recovery efficiency, and reduce stress for families and healthcare providers in the PACU.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Effect of Ketamine vs. Ketamine-Midazolam vs. Ketamine-Propofol on Post-Tonsillectomy Agitation in Kids”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Pain:
Pain is a significant clinical concern in perioperative settings, as it can lead to emotional distress and complications such as emergence agitation. Proper pain management protocols are crucial to minimize postoperative discomfort and improve patient outcomes, especially in pediatric populations where effective communication about pain may be limited.

2) Study (Studying):
The study represents a systematic investigation into the effects of specific drug combinations on emergence agitation during surgery. Careful design and execution are essential to ensuring unbiased results that contribute to evidence-based medicine, which ultimately informs clinical practices and enhances patient care in pediatric anesthesia contexts.

3) Table:
In scientific literature, tables serve as vital tools for presenting complex data in a clear and organized manner. They allow for straightforward comparison of variables such as patient demographics, outcomes, and clinical scores, facilitating easier analysis of results over time and increasing the accessibility of information for readers.

4) Post:
The term 'post' relates to the postoperative period, which is critical for patient recovery after anesthesia. Managing factors such as agitation, pain, and monitoring vital signs is essential during this time. Ensuring a smooth transition in the post-anesthesia care unit can significantly affect overall patient satisfaction and outcomes.

5) Drug:
Drugs play a crucial role in managing anesthesia and postoperative complications like emergence agitation. The study evaluates the effectiveness of various anesthetic agents, highlighting the need for tailored pharmacological approaches to minimize adverse effects, promote recovery, and ensure patient safety during and after surgical interventions.

6) Ter:
The abbreviation 'Ther' typically implies a focus on therapeutic interventions. Within the context of this study, it emphasizes evaluating medication effectiveness in treating specific conditions like emergence agitation, thereby contributing to the overall therapeutic knowledge base and enhanced treatment strategies for managing complications related to anesthesia.

7) Entering:
Entering refers to the transition of patients into the post-anesthesia care unit (PACU) after surgery. This moment is critical for monitoring recovery, assessing agitation, and evaluating vital signs. Effective management during this phase can directly influence the patient's overall recovery and the incidence of complications.

8) Science (Scientific):
The study exemplifies the application of scientific principles to understand the effects of drugs on human subjects post-anesthesia. It highlights the importance of rigorous methodology, data analysis, and ethical considerations in medical research, reinforcing science as a foundation for informing clinical practices and improving healthcare outcomes.

9) Blood:
Blood monitoring is integral during and after surgery to assess a patient's hemodynamic stability and detect potential complications, such as bleeding. Changes in blood pressure and heart rate can indicate adverse reactions to anesthesia or surgical interventions, necessitating continuous monitoring to ensure patient safety and timely interventions.

10) Medicine:
Medicine, particularly anesthesiology, encompasses a range of practices aimed at ensuring patient safety during surgery. This study contributes to the broader medical field by exploring interventions that mitigate postoperative complications, ultimately enhancing recovery protocols and patient-centered care in surgical settings.

11) Hand:
The term 'hand' often symbolizes the roles of healthcare professionals in executing surgical and medical procedures. It emphasizes the importance of skilled practitioners in carefully administering anesthesia and monitoring patient responses, ensuring effective interventions to enhance safety and outcomes during surgical procedures.

12) Knowledge:
Knowledge refers to the understanding and information gained through research and clinical experiences. The study aims to expand the knowledge base surrounding postoperative care, particularly regarding managing emergence agitation in pediatric patients, which is crucial for improving clinical practices and training healthcare professionals.

13) Bleeding:
Bleeding is a potential postoperative complication, particularly in surgical procedures like adenotonsillectomy. Managing blood loss is crucial for patient safety and recovery; thus, understanding how anesthetic interventions may influence bleeding risk is an important aspect of preoperative planning and postoperative care strategies.

14) Anxiety:
Anxiety is a common issue for patients undergoing surgery, often exacerbated by preoperative procedures and anesthesia. Addressing anxiety through effective communication and pharmacological interventions can improve patient experiences and reduce complications like emergence agitation during recovery, leading to better overall outcomes.

15) Pharmacology:
Pharmacology is the study of drug actions and interactions within the body. This study integrates principles of pharmacology to evaluate specific drug combinations aimed at minimizing emergence agitation and improving recovery, thereby underscoring the importance of understanding pharmacological effects in anesthetic practice.

16) Arrangement:
Arrangement often refers to the systematic organization of study protocols or the scheduling of surgery and recovery procedures. Proper arrangement is key in clinical trials to ensure unbiased data collection and effective resource utilization, ultimately leading to improved patient care and outcomes.

17) Performance:
Performance evaluates the effectiveness of specific drug combinations in reducing emergence agitation and promoting stability in patients postoperatively. Understanding the pharmacodynamic and pharmacokinetic profiles of the administered drugs establishes a basis for assessing and improving practices in pediatric anesthesia.

18) Activity:
Activity refers to the level of movement or responsiveness in patients, particularly during the recovery phase from anesthesia. Monitoring activity levels using scales like RASS helps assess the effectiveness of anesthetic drugs and ensures patient safety during the transition from anesthesia to consciousness.

19) Relative:
In research, 'relative' often describes the comparison of outcomes or variables between different study groups. The study examines the relative effectiveness of various drug combinations, highlighting their impacts on emergence agitation and recovery times compared to standard treatments or control groups.

20) Kamali:
Kamali likely refers to an author or researcher who contributed to the study. Including specific researchers emphasizes the collaborative nature of clinical research and the importance of individual contributions to advancing understanding in medical science and improving patient care.

21) Cancer:
Cancer represents a significant health concern that often leads to complex treatment protocols, including surgical interventions. Understanding the different aspects of patient care, pain management, and anesthesia in cancer patients emphasizes the need for specialized approaches to ensure effective treatment and recovery.

22) Nausea:
Nausea is a common postoperative symptom that can severely impact recovery quality. Managing nausea through effective antiemetic protocols is vital for enhancing patient comfort and overall satisfaction during the post-anesthesia care phase, influencing discharge readiness and long-term outcomes.

23) Repair:
Repair refers to surgical procedures aimed at correcting physical abnormalities or injuries. In the context of this study, it particularly highlights surgical interventions, such as adenotonsillectomy, where effective management of anesthesia and postoperative complications can enhance recovery and quality of care.

24) Chang:
Chang likely refers to a researcher or contributor recognized in the field of anesthesia or pain management. Their work may involve developing therapeutic strategies or conducting studies that enhance understanding of patient care, thus contributing to evidence-based practices and improving surgical outcomes.

25) Annal:
'Annal' typically refers to the annual publication of findings or research summaries in medical journals. Highlighting annals emphasizes the importance of disseminating research results to keep healthcare professionals informed of the latest advances and ongoing discussions in the medical community.

26) Rules:
Rules generally refer to the ethical and methodological guidelines governing clinical research. Adhering to established rules ensures the integrity, validity, and reliability of study results, safeguarding participant welfare while contributing to advancements in medical knowledge and practice.

27) Field:
Field signifies the broader discipline of medicine encompassing various specialties, including anesthesiology. Within this context, it underscores the collaborative nature of scientific inquiry, highlighting how interdisciplinary approaches enhance understanding of patient care, treatment efficacy, and improve overall health outcomes.

28) Cai (Caí):
Chai may refer to a researcher contributing to the study or may represent findings regarding anesthesia protocols in various patient demographics. Understanding diverse contributions highlights the collaborative nature of clinical research and the shared knowledge advancing medical practices.

29) Tai:
Thai may reference a specific cultural or regional context within medical practice, particularly if the study involves patients from Thailand or considers local healthcare practices. Acknowledging cultural variables highlights the importance of context-specific research that addresses diverse patient populations and their unique needs.

30) Life:
Life represents the ultimate goal of medical interventions, which is to improve the health and well-being of individuals. Research aimed at enhancing patient care directly contributes to the quality of life for patients facing surgical procedures or postoperative recovery.

31) Measurement:
Measurement involves quantifying outcomes, such as agitation or recovery metrics, to assess the effectiveness of interventions. Accurate measurement methodologies are essential in clinical research, ensuring that findings are robust, reliable, and contribute to improved health sciences and practices.

32) Discussion:
Discussion refers to the section of research papers where findings are interpreted in the context of existing knowledge. It is crucial for contextualizing results, addressing limitations, and suggesting future research directions to foster ongoing advancements in medical understanding and practice.

33) Vomiting:
Vomiting is a common adverse effect following anesthesia that can lead to patient discomfort and delay recovery. Preventive strategies, including pharmacological interventions, are vital to managing symptoms effectively, improving patient satisfaction, and ensuring efficient transitions from postoperative care to discharge.

34) Nature:
Nature ultimately refers to the inherent characteristics of biological systems, including human responses to anesthesia. Understanding the nature of these responses is crucial for developing effective management strategies, enhancing patient safety, and optimizing treatment outcomes within surgical and recovery settings.

35) Crying:
Crying in pediatric patients may indicate distress or discomfort, particularly following surgery or in response to pain. Addressing the causes of crying is critical for ensuring proper postoperative care, as understanding emotional and physical responses significantly impacts recovery practices and patient satisfaction.

36) Pulse:
Pulse monitoring is essential in anesthesia and postoperative care to assess cardiovascular stability. Changes in pulse rate can signal vital physiological responses during recovery, informing healthcare providers about potential complications and the effectiveness of anesthetic interventions, facilitating timely interventions when necessary.

37) Noise:
Noise in a clinical environment can negatively impact patient recovery, especially in post-anesthesia care settings. High levels of environmental noise may lead to increased anxiety and agitation in patients, emphasizing the need for creating calm and soothing environments during recovery for optimal outcomes.

38) Male:
Male refers to a demographic category in clinical studies that may influence outcomes and responses to anesthesia or medications. Analyzing differences between genders enhances the understanding of various physiological responses, aiding in the development of more tailored and effective treatment strategies.

Other Science Concepts:

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Discover the significance of concepts within the article: ‘Effect of Ketamine vs. Ketamine-Midazolam vs. Ketamine-Propofol on Post-Tonsillectomy Agitation in Kids’. Further sources in the context of Science might help you critically compare this page with similair documents:

Anxiety, Medical science, Acute pain, Ophthalmic Surgery, Blood-pressure, Conflict of interest, Inclusion criteria, Exclusion criteria, Clinical trial, Statistical Significance, Ethics committee, Heart rate, Study group, Cataract surgery, Cognitive impairment, Airway obstruction, Surgical Procedure, Muscle Relaxation, Pain score, General anesthesia, Random allocation, Post-operative pain, Post-Operative Pain Management, Pediatric patient, Postoperative Pain, Brain damage, Nasogastric tube, Hospital stay, Risk factor, Recovery time, Bladder distention, Double blind clinical trial, Gastric cancer, General anaesthesia, Environmental noise, Adverse event, American Society of Anesthesiologist, Anesthesia technique, Accessibility of medicines, Pediatric Anesthesia, Adenotonsillectomy, Psychiatric Problems, Benzodiazepine, Tonsillectomy, Post operative complication, Post anaesthesia care unit, Preoperative pain management, Randomised, double-blind, Urinary catheter, Authors contribution, Study material, Heart damage.

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