The effect of KETODEX on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane based-anesthesia Sally M. Hadi a,1 , Amin J. Saleh a,1 , Yong Zhong Tang a , Ahmed Daoud b , Xi Mei a , Wen Ouyang a, * a Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, PR China b Department of Otorhinolaryngology, Suez Canal Authority Hospital, Ismailia, Egypt 1. Introduction Adenotonsillectomy is one of the most common surgical procedure preformed in children [1]. Sevoflurane is often used in preschool children anesthesia because its a fast and well tolerated inhaled agent, hemodynamically stable, low hepatotox- icity, and rapid emergence from anesthesia. However, postsev- flurane emergence agitation (EA) is a common phenomenon in children with a wide incidence range up to 80% [2], depending on the definition, assessment tools and time period of monitoring during recovery [3]. Emergency agitation is characterized by a short period of disorientation, agitation, delusion, hallucination, restlessness, inconsolable crying and cognitive changes plus memory impairment [4]. The etiology of EA remain unknown [5]. However, there are several risk factors may be involved in EA development, such as preschool age, pain, type of surgery (ophthalmology or otorhinolaryngology) and inhalation agents associated with fast emergence and duration of anesthesia [6]. Several prospective clinical trail studies suggested different pharmacological methods for either treatment or prophylaxis from EA after anesthesia and surgery with variable success such as analgesics, opioids, benzodiazepines, and clonidine [2,4]. However, the method of choice remains controversial. Ketamine is a non-competitive N-methyl-D-aspartate receptor antagonist an effective drug for sedation, analgesia and amnesia. International Journal of Pediatric Otorhinolaryngology xxx (2015) xxx–xxx A R T I C L E I N F O Article history: Received 17 December 2014 Received in revised form 10 February 2015 Accepted 12 February 2015 Available online xxx Keywords: Anesthesia Adenotonsillectomy Dexmedetomidine Emergence agitation Ketamine Children A B S T R A C T Background: Postoperative emergency agitation (EA) is a common problem often observed in children undergoing general anesthesia. The purpose of this study was to evaluate whether a bolus of intraoperative low-dose ketamine followed by dexmedetomidine i.v. could reduce the incidence of EA in children undergoing adenotonsillectomy following sevoflurane-based anesthesia. Methods: A total of 92 children undergoing adenotonsillectomy, aged 3–7 years, were randomly allocated to receive either low-doseketamine 0.15 mg/kg followed by dexmedetomidine 0.3 mg/kg i.v. (KETODEX, n = 45) or volume-matched normal saline (Control, n = 47), about 10 min before the end of surgery. Anesthesia was induced and maintained with sevoflurane. Postoperative pain and EA were assessed with objective pain score (OPS) and the Pediatric Anesthesia Emergence Delirium scale (PAED), respectively. EA was defined as a PAED  10 points. Recovery profile and postoperative complications were recorded. Result: The incidence and severity of EA was lower in KETODEX group than controls (11% vs. 47%) and (2% vs. 13%), respectively (P < 0.05). The frequency of fentanyl rescue was lower in KETODEX group than in controls (13.3 vs. 38.3%, P < 0.05). Heart rate during extubation was significantly higher in the control group compared with children who received KETODEX (P < 0.05). The incidence of postoperative pain was significantly less in the KETODEX group (15.5% vs. 63.8%, P < 0.05). Times to interaction and extubation were significantly longer in the KETODEX group (P < 0.05). Conclusion: KETODEX reduces the incidence and severity of EA in children undergoing adenotonsil- lectomy following sevoflurane-based anesthesia and provided smooth extubation. ß 2015 Published by Elsevier Ireland Ltd. * Corresponding author. Tel.: +86 139 749 4441. E-mail address: ouyangwen133@vip.sina.com (W. Ouyang). 1 These authors contributed equally to this work. G Model PEDOT-7471; No. of Pages 6 Please cite this article in press as: S.M. Hadi, et al., The effect of KETODEX on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane based-anesthesia, Int. J. Pediatr. Otorhinolaryngol. (2015), http://dx.doi.org/ 10.1016/j.ijporl.2015.02.012 Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo ur n al ho m ep ag e: ww w.els evier .c om /lo cat e/ijp o r l http://dx.doi.org/10.1016/j.ijporl.2015.02.012 0165-5876/ß 2015 Published by Elsevier Ireland Ltd.