Pediatric anesthesia & critical care
Preoperative Oral Esketamine for Perioperative Comfort in Children Undergoing Adenotonsillectomy: A Randomized, Double‐Blind, Dose‐Finding Study
Authors' conclusion
Preoperative oral esketamine (1-3 mg/kg) enhances perioperative comfort in children undergoing adenotonsillectomy. The 2 mg/kg dose offers the best balance of efficacy and safety, while 3 mg/kg provides superior analgesia and opioid sparing.
Study context
- Population
- Children (ASA I–II, 1–6 years) undergoing adenotonsillectomy
- Participants
- 99 children
- Comparison
- Oral esketamine 1, 2, or 3 mg/kg vs oral 10% glucose (control) 30 min before anesthesia
- Controln = 26
- EK1n = 26
- EK2n = 23
- EK3n = 24
- Primary endpoint
- Ramsay Sedation Scale (RSS) at venous cannulation
- Follow-up
- At venous cannulation
Methodological detailsdose-finding
- Dose-finding
Primary result
As reported in the abstract
Control
1.00
median · IQR 1.00–2.00
EK1
2.00
median · IQR 1.75–3.00
EK2
2.00
median · IQR 1.00–3.00
EK3
3.00
median · IQR 2.00–3.37
EK1 vs control: P = 0.028 · EK2 vs control: P = 0.049 · EK3 vs control: P < 0.001
- All esketamine doses improved sedation and analgesia at cannulation, with largest effect at 3 mg/kg
- overall p < 0.001
Secondary outcomes
| Outcome | Control | EK1 | EK2 | EK3 | P value |
|---|---|---|---|---|---|
| FLACC pain score at venous cannulation (primary outcome)EK1 vs control | 6.00 (3.00-7.00) | 2.50 (1.00-4.00) | 2.00 (0.00-4.00) | 0.00 (0.00-1.75) | P = 0.016 |
| FLACC pain score at venous cannulation (primary outcome)EK2 vs control | P = 0.001 | ||||
| FLACC pain score at venous cannulation (primary outcome)EK3 vs control | P < 0.001 | ||||
| PAED score (primary outcome) · 15 min after extubationEK2 vs control · lower in EK2 than control | 10.00 [6.00-12.00] | — not stated in the abstract | 5.00 [2.00-10.00] | — not stated in the abstract | P = 0.048 |
— not stated in the abstract
Remifentanil consumption
- Reduced in EK3
- 120.00 [80.00-159.50] vs. 240.00 [160.00-315.00] μg, p = 0.001
Postoperative pain · 2-6 h, persisting to 48 h in EK3
- Lower at 2-6 h in EK2 and EK3
- P < 0.05
- Persisting to 48 h in EK3
- P < 0.05
Sleep quality · 24 h and 48 h
- Improved in EK3 at 24 h
- P = 0.023
- Improved in EK3 at 48 h
- P = 0.032
Safety
Adverse events
- Did not differ significantly
Original publication
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