الفهرس 
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Abstract
O
ver the years, Sevoflurane has been proved to be the most effective inhalational anesthetic for induction and maintenance of general anesthesia in pediatrics. However, one of the downsides of utilizing Sevoflurane anesthesia in pediatrics is emergence agitation (EA). (Abu-Shahwan and Chowdary, 2008). Agitation is defined as behavior of physical or emotional distress that includes any of the following behaviors alone or in combination: crying, restlessness, thrashing, verbal out‐bursts, kicking, or biting; purposeful and non-purposeful behaviors in children that may be coherent or incoherent (Ringblom et al., 2018).
One of the causes of developing EA is the use of Sevoflurane anesthesia. It has been found to increase the risk of agitation on emergence from anesthesia in pediatrics when compared with other more soluble anesthetic even in the absence of any surgical intervention (Ramachandran et al., 2021).
EA occurs within the first 30 minutes after emergence and in most cases will be self-limiting, however, it still carries the risks of self-injury particularly in pediatric patients as they cry heavily and try to free themselves where they may pull on their intravenous line or harm themselves. Also, it can be a cause of stress to both caregivers, where it can be a heavy burden on the medical staff and may prolong the recovery period and the hospital stay and families where parents may lose confidence and satisfaction in the anesthesia and surgery (Ramachandran et al., 2021).
Therefore, effective treatment requires understanding and targeting the multifactorial causes of the agitation, including pain, psychiatric symptoms, physical distress, and environmental triggers (Zainal Abidin et al., 2021).
Different strategies have been employed to limit the incidence and severity of EA. This includes the presence of parents on emergence, physical restraints, and other non-pharmacologic strategies which include effective communication, behavioral strategies, and multidisciplinary collaboration (Abdelzaam and Mahdy, 2020). Also, several drugs have been used to control this phenomenon such as opioids, propofol, midazolam, ketamine, dexmedetomidine, magnesium and ketorolac (Zhang et al., 2021).
However, the use of sedatives in the management of EA carries the risk of its harmful side effects which can lead to an increased length of stay in the post-anesthesia care unit (PACU), resulting in patient discomfort and increased perioperative costs (Alghamdi et al., 2020).
Ketamine is an N-Methyl-D-aspartate (NMDA) receptor antagonist used clinically as an anesthetic, sedative, and analgesic in pediatric patients. It has been successfully used to reduce the incidence of emergence agitation in children receiving sevoflurane anesthesia but may be associated with delayed recovery (Chen et al., 2013) (Tan et al., 2019). In addition, magnesium sulphate, another N-methyl-D-aspartate (NMDA) receptor antagonist, was also found to be effective in reducing emergence agitation following sevoflurane anesthesia (Koo et al., 2021).