This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Dalens, B. J. Articles by Truchon, R. J. Y. Search for Related Content PubMed PubMed Citation Articles by Dalens, B. J. Articles by Truchon, R. J. Y. Related Collections Pediatrics Pharmacology

---

PEDIATRIC ANESTHESIA

Prevention of Emergence Agitation After Sevoflurane Anesthesia for Pediatric Cerebral Magnetic Resonance Imaging by Small Doses of Ketamine or Nalbuphine Administered Just Before Discontinuing Anesthesia

Department of Anesthesiology, CHUL du Centre Hospitalier Universitaire de Québec, Québec, Canada

Address correspondence to Bernard J. Dalens, Department of Anesthesiology, CHUL du Centre Hospitalier Universitaire de Québec, 2705, boul. Laurier - Local 2206, Sainte-Foy, Québec, Canada, G1V 4G2. Address e-mail to bdalens{at}videotron.ca.

Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. We hypothesized that delaying their administration until the end of the procedure would prevent emergence agitation without prolonging patient wake-up and discharge times from the postanesthesia care unit. We performed a double-blind study involving 90 patients (aged 6 mo to 8 yr) randomly allocated to 1 of 3 groups receiving either saline (S-group), ketamine (0.25 mg/kg) (K-group), or nalbuphine (0.1 mg/kg) (N-group) at the end of an MRI procedure under sevoflurane anesthesia. We evaluated emergence conditions, sedation/agitation status and completion of discharge criteria at 30 min. The three groups were comparable in age, sex ratio, physical status, and associated medical disorders. Emergence conditions did not differ significantly. There were significantly more agitated children, at all times, in the S-group and more obtunded patients at early times (5 and 10 min) in both K- and N-groups. All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.

This article has been cited by other articles:

				A.-M. Machata, H. Willschke, B. Kabon, S. C. Kettner, and P. Marhofer Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging Br. J. Anaesth., August 1, 2008; 101(2): 239 - 243. [Abstract] [Full Text] [PDF]