The effect of KETODEX on the incidence and severity of emergence agitation in children undergoing adenotonsillectomy using sevoflurane based-anesthesia

Int J Pediatr Otorhinolaryngol. 2015 May;79(5):671-6. doi: 10.1016/j.ijporl.2015.02.012. Epub 2015 Feb 19.


Background: Postoperative emergency agitation (EA) is a common problem often observed in children undergoing general anesthesia. The purpose of this study was to evaluate whether a bolus of intraoperative low-dose ketamine followed by dexmedetomidine i.v. could reduce the incidence of EA in children undergoing adenotonsillectomy following sevoflurane-based anesthesia.

Methods: A total of 92 children undergoing adenotonsillectomy, aged 3-7 years, were randomly allocated to receive either low-doseketamine 0.15 mg/kg followed by dexmedetomidine 0.3 μg/kg i.v. (KETODEX, n=45) or volume-matched normal saline (Control, n=47), about 10 min before the end of surgery. Anesthesia was induced and maintained with sevoflurane. Postoperative pain and EA were assessed with objective pain score (OPS) and the Pediatric Anesthesia Emergence Delirium scale (PAED), respectively. EA was defined as a PAED≥10 points. Recovery profile and postoperative complications were recorded.

Result: The incidence and severity of EA was lower in KETODEX group than controls (11% vs. 47%) and (2% vs. 13%), respectively (P<0.05). The frequency of fentanyl rescue was lower in KETODEX group than in controls (13.3 vs. 38.3%, P<0.05). Heart rate during extubation was significantly higher in the control group compared with children who received KETODEX (P<0.05). The incidence of postoperative pain was significantly less in the KETODEX group (15.5% vs. 63.8%, P<0.05). Times to interaction and extubation were significantly longer in the KETODEX group (P<0.05).

Conclusion: KETODEX reduces the incidence and severity of EA in children undergoing adenotonsillectomy following sevoflurane-based anesthesia and provided smooth extubation.

Keywords: Adenotonsillectomy; Anesthesia; Children; Dexmedetomidine; Emergence agitation; Ketamine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adenoidectomy
  • Adrenergic alpha-2 Receptor Agonists / therapeutic use*
  • Airway Extubation
  • Anesthesia Recovery Period
  • Anesthesia, General
  • Anesthetics, Dissociative / therapeutic use*
  • Anesthetics, Inhalation / therapeutic use
  • Child
  • Child, Preschool
  • Dexmedetomidine / therapeutic use*
  • Double-Blind Method
  • Female
  • Heart Rate / drug effects
  • Humans
  • Intraoperative Care
  • Ketamine / therapeutic use*
  • Male
  • Methyl Ethers / therapeutic use
  • Pain, Postoperative / prevention & control
  • Postoperative Complications / prevention & control*
  • Psychomotor Agitation / prevention & control*
  • Sevoflurane
  • Time Factors
  • Tonsillectomy


  • Adrenergic alpha-2 Receptor Agonists
  • Anesthetics, Dissociative
  • Anesthetics, Inhalation
  • Methyl Ethers
  • Sevoflurane
  • Dexmedetomidine
  • Ketamine