The effect of different drugs on sevoflurane emergence agitation in pediatric patients undergoing hypospadias repair surgery

Background
Various methods are used to decrease the incidence of emergence agitation (EA) in children following general anaesthesia with sevoflurane.
Objective
The present study aims to compare the effect of intravenous injection of small dose of propofol, fentanyl or ketamine at the end of surgery, just before the discontinuation of sevoflurane on the incidence and severity of sevoflurane emergence agitation in children undergoing hypospadias repair operations.
Patients and methods
Eighty patients undergoing elective hypospadias repair under sevoflurane general anaesthesia with caudal block were randomly divided into four groups (20 patients each); group P received intravenous 1 mg/kg propofol, group K received intravenous 0.25 mg/kg ketamine, group F received intravenous 1 μg/kg fentanyl, and group S received intravenous saline as control group. All those injections were given just before the discontinuation of sevoflurane. The emergence agitation was evaluated by emergence agitation scale from awakening every 5 min for 30 min. Complications like laryngospasm, desaturation, cough, and vomiting were recorded. Awakening time and PACU duration were also recorded.
Results
The incidence of emergence agitation was significantly lower in groups P and F ( < 0.05). The time for awakening was significantly prolonged in groups P, K and F ( < 0.05), while PACU duration was significantly prolonged in group F ( < 0.05). No significant complications occurred except a significantly higher incidence of vomiting in group F.
Conclusion
The use of propofol or fentanyl just before the discontinuation of sevoflurane reduces the incidence of emergence agitation in children, on the other hand fentanyl was accompanied with a significantly longer PACU duration and higher incidence of vomiting.