Comparison of the Effect of Esketamine and Sevoflurane for Pediatric Ophthalmological Procedure
Condition: Adverse Event
Study type: Interventional

Summary: 
      Emergence agitation is the most common reason for post-anesthesia care unit delay.
      Sevoflurane is used frequently inhalational anaesthetic agent to provide pediatric
      anaesthesia because of the nonirritant nature. It has been successfully used for keeping
      spontaneous breathing without tracheal intubation. However, sevoflurane may cause emergence
      agitation as the incidence varied from 10%-80%. Although there are many sedative agents to
      reduce its incidence, such as propofol, midazolam, a2 adrenergic receptor agonists and
      ketamine, the efficacy remains limited.

      Ketamine, a neuroleptic anesthetic agent, contains two optical isomers, s(+)-ketamine
      (esketamine) and R(-)-ketamine. Esketamine is a right-handed split of ketamine, which has
      enhanced analgesic potency and lower incidence of psychotropic side effects compared to
      ketamine. It stimulate breathing due to N-Methyl-D-Aspartate receptor blockade, and could
      even effectively countered remifentanil-induced respiratory depression. The investigators
      compared the effectiveness of esketamine and sevoflurane in reducing the incidence of
      emergence agitation after painless ophthalmological procedure in pediatric patients.
    

Detailed description: 
      Ophthalmological procedure such as suture remove, intraocular pressure (IOP) measurement,
      slit-lamp and fundoscopy are most frequently performed in operation with minor surgical
      stimulus, and the the duration of surgery is very short. Several anesthestic agents are
      available,but it is hard to balance short effect and fast rotation in post-anesthesia care
      unit. Emergence agitation is the most common reason for post-anesthesia care unit delay.
      Sevoflurane is used frequently inhalational anaesthetic agent to provide pediatric
      anaesthesia because of the nonirritant nature. It has been successfully used for keeping
      spontaneous breathing without tracheal intubation. However, sevoflurane may cause emergence
      agitation as the incidence varied from 10%-80%. Although there are many sedative agents to
      reduce its incidence, such as propofol, midazolam, a2 adrenergic receptor agonists and
      ketamine, the efficacy remains limited.

      Ketamine, a neuroleptic anesthetic agent, contains two optical isomers, s(+)-ketamine
      (esketamine) and R(-)-ketamine. Esketamine is a right-handed split of ketamine, which has
      enhanced analgesic potency and lower incidence of psychotropic side effects compared to
      ketamine. It stimulate breathing due to N-Methyl-D-Aspartate receptor blockade, and could
      even effectively countered remifentanil-induced respiratory depression. Additionally, several
      studies have reported ketamine could reduced agitation, but there is no study about
      esketamine on emergence agitation. The investigators compared the effectiveness of esketamine
      and sevoflurane in reducing the incidence of emergence agitation after painless
      ophthalmological procedure in pediatric patients.
    

Intervention name(s): Esketamine; Sevoflurane
Intervention type(s): Drug; Drug
Intervention description(s): 0.5 mg/kg esketamine for induction and 0.25 mg/kg esketamine at the beginning of surgery; 5% sevoflurane for induction and 3-4% sevoflurane for maintain
Other intervention name(s): s(+)ketamine; Sevoflurane Inhalation Solution
Intervention MeSH terms: Ketamine; Sevoflurane; Esketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: adverse event; sevoflurane; esketamine