The Impact of Intranasal Esketamine on Emergence Agitation in Children Undergoing Adenotonsillectomy: A Randomized Controlled Study
Bibliographic record
Abstract
Purpose: To investigate the efficacy of intranasal esketamine in reducing the incidence of emergence agitation (EA) in pediatric patients undergoing adenotonsillectomy and to determine the optimal dose of esketamine. Methods: A total of 204 children aged 3– 6 years scheduled for adenotonsillectomy were randomly assigned to three groups. All participants received a standardized anesthetic induction protocol. Following tracheal intubation, they were administered intranasally 0.5 mg/kg esketamine (group LE), 1 mg/kg esketamine (group HE), or an equivalent volume of saline (group C). Anesthesia was maintained with sevoflurane during surgery, and the children were transferred to the post-anesthesia care unit (PACU) after extubation. The highest scores on the Pediatric Anesthesia Emergence Delirium (PAED) scale and the modified Children’s Hospital of Eastern Ontario Pain Scale (m-CHEOPS) in the PACU were recorded. The incidence of EA, defined as PAED ≥ 10, was calculated for each group. Additionally, changes in vital signs after intranasal administration, surgery time, anesthesia time, extubation time, eye-opening time, recovery time, and the incidence of adverse reactions were compared among the three groups. Results: Group LE demonstrated a significantly lower incidence of EA compared with group C (10.45% vs 29.85%, P = 0.005), while no significant difference was observed between group LE and HE (10.45% vs 12.12%, P = 0.760). Relative to Group C, children in Group LE also showed significantly lower PAED ( P = 0.010) and m-CHEOPS scores ( P = 0.023), along with reduced requirements for rescue propofol ( P = 0.005) and rescue fentanyl ( P = 0.013). Groups LE and HE demonstrated comparable performance across these secondary outcomes; however, extubation time was prolonged in Group HE ( P = 0.025). Conclusion: Intranasal esketamine at a dose of 0.5 mg/kg significantly reduces the incidence of EA following pediatric adenotonsillectomy. Increasing the dose to 1 mg/kg does not confer additional benefit in preventing EA and may instead delay extubation. Keywords: esketamine, intranasal, adenotonsillectomy, emergence agitation, children
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".