Objective To observe the effect of preventive application of esketamine and midazolam on awakening agitation and delirium after tonsillectomy and adenoidectomy in children before induction of general anesthesia.

Methods A total of 100 children undergoing elective tonsillectomy and (or)adenoidectomy were selected as study objects, and were divided into E group and M group by random number table method, with 50 case in each group. Immediately after entering the operating room, E group was intravenously given esketamine 0.5 mg/kg, and M group was given midazolam 0.1 mg/kg intravenously. General anesthesia induction and intraoperative anesthesia were maintained in all patients, and all patients were transferred to Post-anesthesia Care Unit (PACU) for resuscitation under general anesthesia after surgery. The occurrence of emergence agitation and emergence delirium, the score of pediatric anesthesia emergence delirium (PAED), the score of Postoperative Pain Scale (FLACC) for children, the time of extubation and the occurrence of postoperative adverse reactions were recorded.

Results The incidence rates of agitation and delirium in E group were lower than those in M group(P < 0.05). The postoperative PAED score, FLACC score and the incidence of body movement after propofol injection in E group were lower than those in M group(P < 0.05). The mean arterial pressure before anesthesia induction (T₀), after anesthesia induction (T₁) and immediately after intubation (T₂) in E group was higher than that in M group, and the extubation time was longer than that in M group (P < 0.05).

Conclusion Esketamine used in tonsillectomy and adenoidectomy in children can significantly reduce the incidence of agitation and delirium, the incidence of body movement and adverse reactions during propofol injection, and have more stable hemodynamics. It can be safely and effectively used in adenoidectomy of tonsillectomy in children and improve the quality of recovery.