Effect of ketamine versus alfentanil following midazolam in preventing emergence agitation in children after sevoflurane anaesthesia: a prospective randomized clinical trial

J Int Med Res. 2014 Dec;42(6):1262-71. doi: 10.1177/0300060514543039. Epub 2014 Sep 12.


Objective: To investigate the effect of intranasal ketamine versus alfentanil in addition to oral midazolam for the prevention of emergence agitation in children.

Methods: Children undergoing urological surgery with sevoflurane anaesthesia received oral midazolam 40 min before induction and were then randomly assigned to receive 2 mg/kg ketamine, 10 µg/kg alfentanil or 1 ml isotonic saline intranasally. Parental separation status and mask acceptance were assessed preoperatively. Emergence agitation was evaluated using a paediatric anaesthesia emergence delirium (PAED) score.

Results: Data from 78 children were evaluated in the study. There were no significant differences between the groups in demographic characteristics, recovery times or parental separation scores. Mask acceptance was significantly better in the ketamine group than in the saline group. The mean PAED score in the ketamine group was significantly better than in the other two groups, but was similar in the saline and alfentanil groups. The incidence of emergence agitation was 3.8%, 36.0% and 40.7% in the ketamine, alfentanil and saline groups, respectively.

Conclusions: The addition of intranasal ketamine to oral midazolam significantly improved the quality of induction and reduced sevoflurane-induced emergence agitation, in children undergoing urological surgery.

Keywords: Child; emergence delirium; general anaesthesia; premedication; sevoflurane.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Alfentanil / therapeutic use*
  • Anesthesia Recovery Period
  • Anesthetics, Inhalation / adverse effects
  • Anesthetics, Inhalation / therapeutic use
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Humans
  • Infant
  • Ketamine / therapeutic use*
  • Methyl Ethers / adverse effects
  • Methyl Ethers / therapeutic use
  • Midazolam / therapeutic use*
  • Preanesthetic Medication / methods*
  • Prospective Studies
  • Psychomotor Agitation / drug therapy
  • Psychomotor Agitation / prevention & control*
  • Sevoflurane


  • Anesthetics, Inhalation
  • Methyl Ethers
  • Alfentanil
  • Sevoflurane
  • Ketamine
  • Midazolam