BACKGROUND: Emergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery. METHODS: Sixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of the 3 groups: group C received normal saline, group K1.0 received ketamine 1.0 mg/kg intravenously before entering the operating room, or group K0.5 received ketamine 0.5 mg/kg 10 min before the end of the surgery. Before induction, the separation anxiety score was evaluated. Extubation time, post-anesthesia care unit stay time, postoperative nausea and vomiting, emergence agitation, and pain were assessed. RESULTS: The group K1.0 had a lower separation anxiety score compared with groups K0.5 and C. Extubation time in group K0.5 was significantly prolonged compared with groups K1.0 and C. The incidence of EA and the modified Children's Hospital of Eastern Ontario Pain Scale were significantly lower in group K1.0 and group K0.5 compared to group C, but there was no significant difference between groups K1.0 and K0.5. CONCLUSIONS: In children undergoing brief ophthalmic surgery with desflurane anesthesia, ketamine 1.0 mg/kg administered before entering the operating room reduced separation anxiety, postoperative pain, and incidence of EA without delay in recovery.
Anesthesia ; Anesthesia, General ; Anxiety, Separation ; Child ; Dihydroergotamine ; Humans ; Incidence ; Isoflurane ; Ketamine ; Ontario ; Operating Rooms ; Pain, Postoperative ; Postoperative Nausea and Vomiting

BACKGROUND AND OBJECTIVES: Magnetic resonance imaging(MRI) with gadolimiun, an intravenous paramagnetic agent, shows non-enhancement of the cranial nerves in normal subjects. In the presence of inflammation or edema, gadolinium is absorbed into these tissues, resulting in enhancement on T1-weighted images. The purpose of this study was to evaluate the clinical implication of gadolinium-enhanced MRI in Bell's palsy. MATERIALS AND METHODS: From 1994 to 1998, 19 patients with Bell's palsy were evaluated to assess the efficacy of gadolinium-enhanced MRI in determining the frequency, the site of facial nerve enhancement, and the relationship between electroneuronography(ENoG) findings and gadolinium-enhanced MRI. The data was compared to 40 patients with sudden sensorineural hearing loss who had temporal bone MRI. RESULTS: On gadolinium-enhanced MRI, 16 of 19 patients had abnormal contrast enhancement of the facial nerve, but nobody had abnormal contrast enhancement of the facial nerve in the control group. In particular, facial nerve enhancement was identified in the distal portion of the internal auditory canal, geniculate ganglion, labyrinthine segment (n=10), tympanic segment (n=10), and mastoid segment (n=7) of the facial nerve. The facial nerve was enhanced more frequently in patients in whom the degeneration of ENoG was more than 50%. The facial nerve was more frequently enhanced in patients who had a higher House-Blackmann grade. CONCLUSION: Gadolinium-enhanced MRI plays a important role in diagnosing Bell's palsy and in predicting the location of pathology of the facial nerve.
Bell Palsy* ; Cranial Nerves ; Edema ; Facial Nerve ; Gadolinium ; Geniculate Ganglion ; Hearing Loss, Sensorineural ; Humans ; Inflammation ; Magnetic Resonance Imaging* ; Mastoid ; Pathology ; Temporal Bone