BENEFITS OF KETAMINE AND DEXMEDETOMIDINE IN PEDIATRIC POPULATION FOR EMERGENCE DELIRIUM: A CASE SERIES

Abstract

Emergence delirium (ED) is common occurrence in children in the immediate postoperative period receiving sevoflurane-based general anaesthesia. It manifests as crying, excitation, agitation, delirium and behavioural disturbances during early emergence from
anaesthesia. Several clinical studies suggest different pharmacological methods for either treatment or prophylaxis from ED after anaesthesia with variable success rate. However, the method of choice remains controversial. Ketamine is a non-competitive N-methyl-d-aspartate receptor antagonist with good sedation, analgesia and amnesia properties. Dexmedetomidine is a selective α2-adrenoceptor agonist with sedative, analgesic and anxiolytic properties. Both ketamine and dexmedetomidine has shown to benefit emergence delirium. 14 children undergoing lower abdominal surgery were included in the case series. Anaesthesia was induced
with injection propofol 2mg/kg body weight IV and maintained with sevoflurane. Children between 1-7 years of age received injection 0.5mg/kg ketamine IV and injection 0.5mcg/kg dexmedetomidine IV as intermittent doses throughout the procedure. Post-operative ED was assessed with Pediatric Anaesthesia Emergence Delirium (PAED) Scale. ED was defined as PAED >/=10. The severity of ED was reduced with low dose ketamine and dexmedetomidine and post-operative recovery was good. Low dose ketamine and dexmedetomidine reduces severity of ED in children undergoing lower abdominal surgeries with sevoflurane-based anaesthesia. Provides smooth extubation and good post-operative recovery.