Efficacy of ketamine in prevention of agitation in children undergoing magnetic resonance imaging under face mask sevoflurane: A randomized trial

Background
Emergence agitation (EA) is a common distressing problem in children after sevoflurane general anesthesia. The aim of the present study was to test the efficacy of ketamine in prevention of EA after sevoflurane general anesthesia in children undergoing magnetic resonance imaging (MRI) scan. Also, we evaluated the safety and efficacy of the face mask for administration of sevoflurane anesthesia in children.
Methods
In this randomized study, 120 children aged 2–7 years (ASA I or II) of either sex scheduled for elective MRI scan under sevoflurane anesthesia were enrolled in the study protocol. Patients were randomly allocated to one of 3 groups: saline group receiving normal saline ( = 40), ketamine 0.25 group receiving 0.25 mg/kg of ketamine intravenously 10 min prior the end of the procedure ( = 40), and ketamine 1.0 group receiving 1.0 mg/kg of ketamine intravenously before sevoflurane induction, ( = 40). Anesthesia was provided with sevoflurane in 100% oxygen. EA score, pausing of the scan, scan time, discharge time and any reported adverse events were recorded.
Results
No significant differences as regards age, weight, sex, or ASA score were found among the studied groups. Children in ketamine 1.0 group reported significant lower EA score in comparison with ketamine 0.25 and saline groups ( < 0.05). Ketamine 0.25 group reported significant lower EA score in comparison with saline group ( < 0.05). Children in ketamine 1.0 group reported significant lower incidence of pausing in comparison with ketamine 0.25 and saline groups ( < 0.05). No significant differences as regards nausea, vomiting, desaturation, scan and discharge times among the studied groups ( < 0.05) were found.
Conclusion
Ketamine premedication was effective in reducing EA without delay in recovery and significantly reduced the incidence of pausing of MRI scan.