The Impact of Intranasal Esketamine on Emergence Agitation in Children Undergoing Adenotonsillectomy: A Randomized Controlled Study.
Jiajia Li, Gaili Jia, Ruixian Wang, Ruofang Zheng, Kaiming Yuan
Drug Design, Development and Therapy 2025 DOI: 10.2147/dddt.s553693 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 204 |
| Population | Children aged 3-6 years undergoing adenotonsillectomy |
| Intervention | Intranasal esketamine |
| Dose | 0.5 mg/kg, 1 mg/kg |
| Topics | Esketamine |
| Keywords | Adenotonsillectomy Children Emergence agitation Intranasal esketamine Pediatric recovery |
| Key findings | Intranasal esketamine at 0.5 mg/kg significantly reduces emergence agitation incidence compared to placebo, while 1 mg/kg provides no additional benefit and prolongs extubation time. |
Abstract
To investigate the efficacy of intranasal esketamine in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing adenotonsillectomy and to determine the optimal dose of esketamine. A total of 204 children aged 3-6 years scheduled for adenotonsillectomy were randomly assigned to three groups. All participants received a standardized anesthetic induction protocol. Following tracheal intubation, they were administered intranasally 0.5 mg/kg esketamine (group LE), 1 mg/kg esketamine (group HE), or an equivalent volume of saline (group C). Anesthesia was maintained with sevoflurane during surgery, and the children were transferred to the post-anesthesia care unit (PACU) after extubation. The highest scores on the Pediatric Anesthesia Emergence Delirium (PAED) scale and the modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) in the PACU were recorded. The incidence of EA, defined as PAED ≥ 10, was calculated for each group. Additionally, changes in vital signs after intranasal administration, surgery time, anesthesia time, extubation time, eye-opening time, recovery time, and the incidence of adverse reactions were compared among the three groups. Group LE demonstrated a significantly lower incidence of EA compared with group C (10.45% vs 29.85%, P = 0.005), while no significant difference was observed between group LE and HE (10.45% vs 12.12%, P = 0.760). Relative to Group C, children in Group LE also showed significantly lower PAED (P = 0.010) and m-CHEOPS scores (P = 0.023), along with reduced requirements for rescue propofol (P = 0.005) and rescue fentanyl (P = 0.013). Groups LE and HE demonstrated comparable performance across these secondary outcomes; however, extubation time was prolonged in Group HE (P = 0.025). Intranasal esketamine at a dose of 0.5 mg/kg significantly reduces the incidence of EA following pediatric adenotonsillectomy. Increasing the dose to 1 mg/kg does not confer additional benefit in preventing EA and may instead delay extubation.
Comparable studies
Other randomized controlled trials on esketamine, most cited first.
Citations in the library
Cites 4
- Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression JAMA Psychiatry December 27, 2017
- Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent The Journal of Clinical Psychiatry May 11, 2020
- Efficacy of intravenous ketamine and intranasal esketamine with dose escalation for Major depression: A systematic review and meta-analysis. Journal of Affective Disorders July 1, 2024
- The Impact of Preoperative Low-Dose Esketamine and Dexmedetomidine Nasal Administration on the Emergence Delirium in Children Undergoing Fiber Bronchoscopy: A Prospective Randomized Controlled Trial. Clinical Neuropharmacology