The effect of low dose nalbuphine or ketamine in the prevention of emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy with or without adenoidectomy

Abstract

Emergence agitation not only poses a risk to children but also increases stress on nursing staff and reduces parent and/or caregiver satisfaction with the anaesthesia method. Therefore, efforts should be made to prevent EA. As the use of volatile anesthetics has been shown to confer the greatest risk of EA, intravenous anaesthesia using propofol—shown to reduce risk of EA is considered the most appropriate means of inducing anaesthesia in children. Furthermore, analgesics and sedatives should be administered in an appropriate and timely manner in response to the development of EA. In such cases, thorough follow-up and observation are imperative and should be performed until all discharge criteria are satisfied. In summary, no single factor in isolation could be identified as causing postoperative agitation, and the condition should be considered to be a syndrome with biological, pharmacological, psychological and social components and one which anesthetists should be prepared to identify and to prevent and to intervene appropriately when necessary. For children, certain measures are recommendable in order to avoid or minimize the occurrence of postoperative agitation.