Rehab Abd El Fattah Helal Motaz Amr Abu Sabaa Shaimaa El Said Shaban

Keywords: Child, Ketamine, Emergence Delirium, Melatonin, Squint

Abstract

Background & objectives: Emergence agitation (EA) is a common incident following sevoflurane anesthesia, especially in children. Various pharmacological agents have been tried to prevent or at least minimize it with variable success. We aimed to evaluate the prophylactic value of oral melatonin versus oral ketamine against the incidence of EA, postoperative sedation, as well as postoperative pain in pediatric patients planned for squint surgery under sevoflurane anesthesia.

Methodology: Ninety children aged 3-5 years, of both genders, were randomized to receive either plain honey (control group or Group C), oral ketamine (Group K), or oral melatonin (Group M) before induction of anesthesia. Incidence of EA, parent separation and mask acceptance, postoperative pain scores, as well as total rescue 24 h fentanyl consumption were noted.

Results EA incidence was significantly reduced in Groups K and M compared to the control group (16.66% vs. 13.33% vs. 46.66%; P = 0.008). Pairwise comparison revealed a P value of 0.026 between Group C and Group K, and 0.011 between Group C and Group M, with no significant difference detected in the incidence of EA between Group K and Group M. Pain scores remained significantly lower up to 10 min in Groups K and M (P <  0.001), with better parent separation and mask acceptance along with significantly less fentanyl consumption in both groups as compared to the control group (P < 0.05).  

Conclusions Preemptive oral administration of ketamine or melatonin, both effectively lower the incidence of emergence agitation. Furthermore, it provided better conditions for parent separation and mask acceptance and decreased rescue analgesics requirement in pediatric patients undergoing squint surgery.

Abbreviations: EA: emergence agitation, ED: emergence delirium, PSAS: Parent Separation Anxiety Scale, PAED: Pediatric Anesthesia Emergence Delirium, PACU: Post-anesthesia care unit

Clinical trial registration number: PACTR202402880294495

Keywords: Child; Ketamine; Emergence Delirium; Melatonin; Squint

Citation: Abu Sabaa MA, Shaban SES, Helal RAEF. Effect of oral melatonin versus oral ketamine on the incidence of emergence delirium in children undergoing squint surgery: a prospective randomized controlled trial. Anaesth. pain intensive care 2025;29(4):341-48. DOI: 10.35975/apic.v29i4.2819

Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025