Original Article

Comparison of the Effect of Thiopental Sodium with Midazolam-ketamine on Post-tonsillectomy Agitation in Children

Abstract

The aim of this study was to determine the effect of thiopental sodium with that of midazolam-ketamine on relieving agitation after tonsillectomy in children. In a clinical trial, 50 children aged 5-10 years, candidates for tonsillectomy, were randomly divided into two 25-member groups. In the first group, thiopental sodium 5mg/kg/IV, and in the second group combination of midazolam 0.01 mg/kg/IV and ketamine 1 mg/kg/IV were used to induce anesthesia. The level of sedation was assessed after surgery with the Ramsay scale. There were no significant differences between the two groups in terms of heart rate, arterial oxygen pressure (PO2), and duration of anesthesia. The Ramsay sedation score was significantly higher in the thiopental sodium group than in the midazolam-ketamine group (P=0.01). Thiopental sodium can be more effective than the combination of midazolam-ketamine for controlling agitation after tonsillectomy in children.

Patel A, Davidson M, Tran MC, et al. Dexmedetomidine Infusion for Analgesia andPrevention of Emergence Agitation in Children with Obstructive Sleep Apnea Syndrome Undergoing Tonsillectomy and Adenoidectomy. Anesth Analg 2010;111(4):1004-10.

Tazeroualti N, De Groote S, De Hert A, et al. Van der Linden.Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective,randomized, controlled trial. Br J Anaesth 2007;98(5):667-71 .

Kim J, Kim SY, Lee JH, et al. Low-Dose Dexmedetomidine Reduces Emergence Agitation after DesfluraneAnaesthesia in Children Undergoing Strabismus Surgery. Yonesi Med J 2014;55(2):508-16.

.Aouad MT, Nasr VG. Emergence agitation in children: an update. Curr Opin Anaesthesiol 2005;18(6):614-9.

Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg 2003;96(6):1625-30.

Dalens BJ, PinardAM, Letourneau DR, et al. 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. Anesth Analg 2006;102(4):1056-61.

Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation inchildren: a meta-analysis of published studies. Br J Anaesth 2010;104(2):216-23 .

Voepel-Lewis T, Burke C, Hadden SM, et al. Nurses' diagnoses and treatment decisions regarding care of the agitated child. J Perianesth Nurs 2005;20(4):239-48.

Fan KT, Lee TH, Yu KL, et al. Influences of tramadol on emergence characteristics from sevoflurane anesthesia in pediatric ambulatory surgery. Kaohsiung J Med Sci 2000;16(5):255-60.

Guler G, Akin A, Tosun Z, et al. Singledosedexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth 2005;15(9):762-6.

Holzki J, Kretz FJ. Changing aspects of sevoflurane in paediatricanaesthesia: 1975-99. Paediatr Anaesth 1999;9(4):283-6.

Galinkin JL, Fazi LM, Cuy RM, et al. Use of intranasal fentanyl in children undergoing UK myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology 2000;93(6):1378-83.

Sathishkumar S, Malviya S, Dorje P. Management of emergence agitation. Anaesthesia 2007;62(5):530-1.

Kuratani N. Emergence agitation in pediatric anesthesia. Masui 2007;56(5):554-9.

Kanto JH. Midazolam: the first water-soluble benzodiazepine. Pharmacology, pharmacokinetics and efficacy in insomnia and anesthesia. Premedication. Pharmacotherapy 1985;5(3):138-55.

Sievers TD, Yee JD, Foley ME, et al. Midazolam for conscious sedation during pediatrie oncology procedures: safety and recovery parameters. Pediatrics 1991; 88(6):1172-9.

Shane SA, Fuchs SM, Khine H. Efficacy of rectal midazolam for the sedation of preschool children undergoing laceration repair. Ann Emerg Med 1994;24(6): 1065-73.

Shoroghi M, Arbabi S, Farahbakhsh F, et al. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment. A double-blinded randomized placebo-controlled trial. Acta Cir Bras 2011;26(4):303-9.

Marx CM, Stein J, Tyler MK, et al. Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. J Clin Oncol 1997;15(1):94-102.

Parker RI, Mahan RA, Giugliano D, et al. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics 1997;99(3):427-31.

SerkanSener, CenkerEken, Carl H. Schultz, Mustafa Serinken, Murat Ozsarac. Ketamine With and Without Midazolam for EmergencyDepartment Sedation in Adults: A Randomized Controlled trial. Ann Emerg Med 2011;57(2):109-14.

Zahavi GS, Dannon P. Comparison of anesthetics in electroconvulsive therapy: an effective treatment with the use of propofol,tomidate, and thiopental. Neuropsychiatric Dise Treat 2014:10:383-9.

Darabi MA, Mireskandari SM, Sadeghi M. Propofol- Alfentanyl versus Midazolam-Ketamine for sedation and analgesia during bone marrow aspiration in children. TUMJ 2007;65(6):17-22.

Khalili GR, Sajedi P, Danesh H. Midazolam versus ketamine in the management of emergence agitation in children undergoing lower abdominal and limb surgeries. TUMJ 2012;69(11): 730-6.

Kaviani N, Eshghi E, Tabibian P. Comparative Evaluation of Sedative Effects of Oral Midazolam and Oral Ketamine in Combination with Inhalation Sedation for Pediatric Behavior Control during Dental Treatment. J Isfahan Dent School 2007;2(4):46-51.

Miller RD, editor. Miller's Anesthesia. 7th ed. Elsevier: Churchill Livingstone; 2010: p. 100-2

Choi HR, Cho JK, Lee S, et al. The effect of remifentanil versus N2O on postoperative pain and emergence agitation after pediatric tonsillectomy/ adenoidectomy. Korean J Anesthesiol 2011;61(2):148-53.

Files
IssueVol 53, No 10 (2015) QRcode
SectionOriginal Article(s)
Keywords
Ketamine Midazolam Thiopental sodium Sedation Agitation

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Toliyat M, Zangoee M, Ahrari S, Zangoee R. Comparison of the Effect of Thiopental Sodium with Midazolam-ketamine on Post-tonsillectomy Agitation in Children. Acta Med Iran. 2015;53(10):637-642.