Pediatric anesthesia & critical care
Intravenous esketamine for the prevention of emergence delirium and negative behavioural changes after paediatric adenotonsillectomy: a randomised controlled trial
Authors' conclusion
In children undergoing adenotonsillectomy, intra-operative low-dose intravenous esketamine significantly reduced emergence delirium and negative behavioural changes without increasing adverse events.
Study context
- Population
- Children aged 3–7 y undergoing adenotonsillectomyrandomised
- Participants
- 228 children
- Comparison
- IV esketamine 0.2 mg.kg-1 vs 0.9% saline after adenoid tissue resection
- Esketaminen = 114
- 0.9% salinen = 114reference
- Primary endpoint
- Co-primary: incidence of emergence delirium and negative behavioural changes on POD 7
Methodological detailssingle-centre, prospective, double-blind
- Single-centre
- Prospective
- Double-blind
Primary result
As reported in the abstract
Esketamine vs 0.9% salineRelative risk (97.5% CI)P value
Emergence delirium
0.40(0.23–0.68)
P < 0.001Negative behavioural changes on POD 7
0.70(0.51–0.95)
P = 0.009Further findings
Outcomes to POD 30 · postoperative day 30
- Benefits extended to POD 30, with improved analgesia and greater parental satisfaction
Safety
- Adverse event rates similar between groups
Original publication
Intravenous esketamine for the prevention of emergence delirium and negative behavioural changes after paediatric adenotonsillectomy: a randomised controlled trial. Anaesthesia. Published 2 October 2025. doi:10.
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