Intravenous esketamine for the prevention of emergence delirium and negative behavioural changes after paediatric adenotonsillectomy: a randomised controlled trial.
Summary
In a double-blind RCT of 228 children undergoing adenotonsillectomy, intraoperative low-dose IV esketamine (0.2 mg/kg) reduced emergence delirium (17% vs 43%) and day-7 negative behavioral changes (42% vs 61%) without increasing adverse events. Benefits persisted to day 30 with better analgesia and parental satisfaction.
Key Findings
- Emergence delirium reduced: 17% (esketamine) vs 43% (saline), RR 0.40 (97.5% CI 0.23–0.68), p<0.001
- Negative behavioral changes at day 7 reduced: 42% vs 61%, RR 0.70 (97.5% CI 0.51–0.95), p=0.009
- Benefits extended to day 30 with improved analgesia and higher parental satisfaction; adverse events similar between groups
Clinical Implications
Consider adding low-dose IV esketamine to pediatric adenotonsillectomy anesthesia protocols to decrease emergence delirium and early postoperative behavioral disturbances, with routine monitoring.
Why It Matters
Provides high-level evidence for a simple intraoperative intervention that substantially reduces pediatric emergence delirium and early maladaptive behaviors.
Limitations
- Single-center study may limit generalizability
- Focused on adenotonsillectomy in 3–7-year-olds; applicability to other surgeries/ages uncertain
Future Directions
Multicenter trials to validate dosing across procedures and ages; evaluate cost-effectiveness and longer-term neurobehavioral outcomes.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention/Treatment
- Evidence Level
- I - Randomized, double-blind controlled trial provides highest level clinical evidence.
- Study Design
- OTHER