Melatonin, ketamine and their combination in half doses for management of sevoflurane agitation in children undergoing adenotonsillectomy

Background
The increased use of sevoflurane has been associated with an increased incidence of emergence agitation (EA), melatonin and ketamine were used for the management of sevoflurane agitation. But their combination was not evaluated up-to-date. So we designed this randomized double blinded controlled study to evaluate the effect of melatonin, ketamine and their combination in half doses in management of EA in children undergoing adenotonsillectomy.
Methods
One hundred twenty children (3–6 years) of both sex were randomly allocated into four equal groups (30 patients each); control group (C) received oral parecetamol 15 mg/kg 1 h before induction and 3 ml intravenous normal saline with induction, melatonin group (M) received oral melatonin 0.1 mg/kg with oral parecetamol 15 mg/kg 1 h before induction and 3 ml intravenous normal saline with induction, ketamine group received oral parecetamol 15 mg/kg 1 h before induction and intravenous ketamine 0.5 mg/kg in a total volume 3 ml with normal saline with induction and melatonin ketamine (MK) group received oral melatonin 0.05 mg/kg with oral parecetamol 15 mg/kg 1 h before induction and intravenous ketamine 0.25 mg/kg with induction in a total volume 3 ml with normal saline. General anesthesia was standardized for all children with inhaled sevoflurane. EA was assessed by 5 point scale at 5, 15 and 30 min.
Results
As regard the EA, there was significant difference between M, K and MK groups when compared to C group at 5 and 15 min. But there was no significant difference between M and K groups when compared with the MK group all over the time of the study.
Conclusion
Melatonin and ketamine were effective in the management of EA. The combination of half doses of them was equally effective as the use of each of them alone.