Analyzing Effects of Esketamine Doses on Emergence Agitation in Pediatric Surgery

In a recent randomized controlled trial conducted at the Affiliated Hospital of North Sichuan Medical College, researchers investigated the effects of varying doses of esketamine on emergence agitation (EA) in children following adenoidectomy and tonsillectomy procedures. The trial enrolled 164 children aged between 3 to 10 years, classified under the American Society of Anesthesiologists (ASA) class I–II, and aimed to determine the efficacy of esketamine in mitigating EA, which can occur in up to 80% of pediatric patients in the post-anesthesia care unit (PACU).

The study compared four groups of children, each receiving different doses of esketamine: 0 mg/kg (control), 0.1 mg/kg, 0.3 mg/kg, and 0.5 mg/kg, with the primary outcome being the Pediatric Anesthesia Emergence Delirium (PAED) scores assessed in the PACU. Notably, the results indicated that higher doses of esketamine significantly reduced the incidence of EA, with the 0.3 mg/kg dosage appearing to offer an optimal balance between safety and efficacy. The PAED scores correlated inversely with the esketamine dosage, highlighting a significant decrease in EA with increasing doses.

According to Dr. Pingping Jiang, lead researcher and anesthesiologist at the Affiliated Hospital of North Sichuan Medical College, "Our findings suggest that esketamine administered prior to anesthesia induction not only reduces the occurrence of EA but also enhances the overall recovery experience for pediatric patients. The data indicated that 0.3 mg/kg is particularly effective without extending recovery times or increasing postoperative complications."

Emergence agitation is a common phenomenon in pediatric anesthesia, often linked to surgical procedures involving the head and neck, where children may exhibit distress and confusion upon waking. This condition can pose risks such as falling from hospital beds, necessitating physical restraints, and can adversely affect parental satisfaction.

Previous studies have explored various pharmacological agents to combat EA, including dexmedetomidine and opioids; however, these interventions often come with their own set of complications. Esketamine, the S-enantiomer of ketamine, has been identified as a promising alternative due to its potent NMDA receptor antagonism, leading to effective sedation and analgesia with a lower risk of adverse effects.

The methodology of this trial followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines, ensuring rigorous ethical standards, as confirmed by the Institutional Ethics Committee of the Affiliated Hospital. Participants were randomly assigned to the treatment groups, and all personnel involved were blinded to the allocation to eliminate bias.

The results of the study were compelling, demonstrating significant differences in PAED scores across the groups: 13.00 for the control group, decreasing to 9.00 for the 0.3 mg/kg and 0.5 mg/kg groups. The incidence of severe EA also decreased significantly, particularly in the 0.3 mg/kg group, where only 10.3% experienced severe agitation compared to 50% in the control group.

In conclusion, the study highlights the efficacy of pre-anesthesia sedation with esketamine in reducing emergence agitation in children undergoing adenoidectomy and tonsillectomy. Further research is warranted to explore the long-term effects and potential applications of esketamine in pediatric anesthesia. As stated by Dr. Jiang, "This research provides valuable insights that can help anesthesiologists make informed decisions regarding sedation practices, ultimately enhancing patient safety and satisfaction during the recovery process."

This clinical trial was registered with the Chinese Clinical Trial Center (registration number ChiCTR2300075038) and conducted from September 2023 to November 2024. The comprehensive findings will contribute to the existing body of knowledge surrounding pediatric anesthesia and the management of emergence agitation.