The effect of intravenous ketamine versus thiopental in the preoperative holding area on the separation anxiety and emergence agitation in children

Background: Pre-anesthetic medication is often required in children to provide anxiolysis and to lessen the psychological impact of hospitalization and procedures. In this study, we compared the effects of intravenous ketamine versus thiopental on the separation anxiety and emergence agitation in children undergoing tonsillectomy/adenoidectomy. Methods: Eighty-two children aged 2-8 years scheduled for adenotonsillectomy were enrolled in this prospective doubleblind, randomized study. The children were divided into two groups to receive either intravenous ketamine 1 mg/kg (Group K) or thiopental sodium 3 mg/kg (Group T) to facilitate separation from their parents in the preoperative holding area. Anesthesia was induced using 5 mg/kg thiopental sodium in group K and 2 mg/kg in group T, and was maintained using sevoflurane. The separation anxiety score, emergence agitation score, time from stopping the anesthetics to eye opening, extubation time, and postoperative nausea and vomiting were assessed. Results: There were no significant differences between groups K and T in the preoperative separation anxiety score, emergence agitation score and postoperative nausea and vomiting. However, time to eye opening from stopping the anesthetics and extubation time were significantly delayed in group K compared with group T. Conclusions: Intravenous ketamine or thiopental in the preoperative holding area are equally effective decreasing anxiety upon separation from parents and may not affect incidence of emergence agitation. The administration of thiopental used to induce anesthesia appears to be a better choice for preanesthetic medication with careful monitoring.