The use of ketamine on emergence agitation in children: a systematic review and meta-analysis

Abstract

Background: Ketamine is believed to reduce the incidence of emergence agitation in children after surgery. However, recent studies reported contradictory findings. Thus, the primary objective of this review and meta-analysis was to investigate the use of ketamine in the reduction of emergence agitation in children undergoing surgery or procedure.

Methods: MEDLINE, EMBASE and CENTRAL were systematically searched from their inception date until March 2024. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. Observational studies, editorial letters or case reports were excluded.

Results: Seventeen studies (1515 patients) were included. Children who received ketamine were reported to have a significantly lower incidence of emergence agitation (OR = 0.27, 95% Confidence Interval: 0.16 to 0.45, p < 0.00001, I² = 61%, certainty of evidence: very low). As compared to placebo, the ketamine group had a significantly lower postoperative pain score (MD = -2.28, 95% Confidence Interval -3.68 to -0.87, p = 0.001, I² = 91%, certainty of evidence: very low). However, no significant differences were observed in the incidence of postoperative nausea and vomiting, desaturation, and laryngospasm.

Conclusion: This meta-analysis highlights the potential benefits of ketamine in the reduction of emergence agitation in children undergoing surgery or diagnostic procedures. However, high degrees of heterogeneity and low certainty of evidence limit the recommendations of the routine use of ketamine in the prevention of emergence agitation in children. Further high-quality randomized controlled trials are warranted before routine use can be recommended.

Prospero registration: CRD42024523680.

Keywords: Emergence agitation; Emergence delirium; Ketamine; Meta-analysis; Pain; Systematic review.