The rapid emergence and recovery from general anesthesia provided by sevoflurane is associated with a frequent incidence of emergence agitation in children. In this study, we compared the emergence and recovery profiles of patients who received sevoflurane with or without intravenous ketorolac or/and fentanyl.

By using a prospective, double blinded design, 60 children of 3 to 10 year of age, scheduled for elective tonsillectomy and adenoidectomy, were anesthetized with sevoflurane (1-3 vol%) in a 50% N₂O/O₂ gas mixture. Patients were randomized to one of four groups (group 1: sevoflurane only, group 2: sevoflurane + ketorolac 0.5 mg/kg, group 3: sevoflurane + fentanyl 1µg/kg, group 4: sevoflurane + ketorolac 0.5 mg/kg + fentanyl 1µg/kg). A blinded observer evaluated each patient using an agitation scale, Faces scale and an Objective pain/discomfort scale.

No significant differences were observed among the four groups regarding age, sex, weight or duration of anesthesia. Recovery and discharge times were not statistically different. The incidence of severe agitation and the scores of Faces scale in the post anesthesia care unit, were significantly lower in groups 2, 3 and 4 than in group 1 (P < 0.05). The incidence of severe pain in the post anesthesia care unit, was significantly lower in groups 3 and 4 than in group 1 (P < 0.05).

We conclude that a dose of 0.5 mg/kg of ketorolac, 1µg/kg of fentanyl or both were sufficient to prevent severe emergence agitation and pain in children undergoing tonsillectomy and adenoidectomy with sevoflurane anesthesia.