Lower Incidence of Emergence Agitation in Children After Propofol Anesthesia Compared with Sevoflurane: a Meta-analysis of Randomized Controlled Trials

Overview

Journal J Anesth

Specialty Anesthesiology

Date 2013 Jun 27

PMID 23800983

Citations 33

Authors

Akihiro Kanaya

Norifumi Kuratani

Daizoh Satoh

Shin Kurosawa

Affiliations

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Abstract

Background: Emergence agitation (EA) from general anesthesia has been reported as an adverse effect of sevoflurane in children. We describe a meta-analysis of randomized controlled trials that compared the incidence of EA between children who underwent sevoflurane anesthesia and those who underwent propofol anesthesia.

Methods: A literature search was conducted to identify clinical trials that met our inclusion criteria. Prospective randomized trials comparing sevoflurane and propofol anesthesia in children less than 15 years of age were included in the meta-analysis. Data from each trial were combined using the random effects model to calculate pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CIs). The heterogeneity of data was assessed by Cochran's Q and I (2) tests. Sensitivity analysis was conducted for study quality, patient age, and type of surgical procedure.

Results: The meta-analysis included 14 studies, in which 560 patients received sevoflurane and 548 received propofol. The pooled OR for EA was 0.25 with a 95 % CI of 0.16-0.39 (P = 0.000), which indicates that propofol anesthesia resulted in a lower incidence of EA. The heterogeneity of data was not statistically supported (P = 0.191). All sensitivity analyses strengthened the evidence for the lower incidence of EA with propofol.

Conclusions: Our meta-analysis demonstrated that EA in children is less likely to occur after propofol anesthesia compared with sevoflurane anesthesia.

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References

Sikich N, Lerman J . Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004; 100(5):1138-45. DOI: 10.1097/00000542-200405000-00015. View

Mehta N, DeMunter C, Habibi P, Nadel S, Britto J . Short-term propofol infusions in children. Lancet. 1999; 354(9181):866-7. DOI: 10.1016/S0140-6736(05)75936-5. View

Ozdemir Kol I, Egilmez H, Kaygusuz K, Gursoy S, Mimaroglu C . Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients. Clin Ther. 2008; 30(1):175-81. DOI: 10.1016/j.clinthera.2008.01.008. View

Tang J, Chen L, White P, Watcha M, Wender R, Naruse R . Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology. 1999; 91(1):253-61. DOI: 10.1097/00000542-199907000-00034. View

Sutton A, Duval S, Tweedie R, Abrams K, Jones D . Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000; 320(7249):1574-7. PMC: 27401. DOI: 10.1136/bmj.320.7249.1574. View

Cravero J, Surgenor S, Whalen K . Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth. 2000; 10(4):419-24. DOI: 10.1046/j.1460-9592.2000.00560.x. View

Kill C, Leonhardt A, Wulf H . Lacticacidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta. Paediatr Anaesth. 2003; 13(9):823-6. DOI: 10.1046/j.1460-9592.2003.01114.x. View

Deng X, Wang M, Ji Y . [Clinical comparison of propofol and remifentanil anaesthesia with sevoflurane and remifentanil anaesthesia for children with cleft lip and palate repair surgery]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2009; 27(5):531-4. View

Gupta A, Stierer T, Zuckerman R, Sakima N, Parker S, Fleisher L . Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004; 98(3):632-41, table of contents. DOI: 10.1213/01.ane.0000103187.70627.57. View

10.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62(10):e1-34. DOI: 10.1016/j.jclinepi.2009.06.006. View

11.

Nakayama S, Furukawa H, Yanai H . Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane. J Anesth. 2007; 21(1):19-23. DOI: 10.1007/s00540-006-0466-x. View

12.

Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C . Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010; 104(2):216-23. DOI: 10.1093/bja/aep376. View

13.

Cohen I, Finkel J, Hannallah R, Hummer K, Patel K . Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth. 2003; 13(1):63-7. DOI: 10.1046/j.1460-9592.2003.00948.x. View

14.

Oh A, Seo K, Kim S, Kim C, Kim H . Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children. Acta Anaesthesiol Scand. 2005; 49(3):297-9. DOI: 10.1111/j.1399-6576.2005.00687.x. View

15.

Komatsu H, Taie S, Endo S, Fukuda K, Ueki M, Nogaya J . Electrical seizures during sevoflurane anesthesia in two pediatric patients with epilepsy. Anesthesiology. 1994; 81(6):1535-7. DOI: 10.1097/00000542-199412000-00030. View

16.

Gurkan Y, Kilickan L, Toker K . Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth. 1999; 9(6):495-9. DOI: 10.1046/j.1460-9592.1999.00399.x. View

17.

Bryan Y, Hoke L, Taghon T, Nick T, Wang Y, Kennedy S . A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth. 2009; 19(7):672-81. DOI: 10.1111/j.1460-9592.2009.03048.x. View

18.

Kuratani N, Oi Y . Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials. Anesthesiology. 2008; 109(2):225-32. DOI: 10.1097/ALN.0b013e31817f5c18. View

19.

Konig M, Varughese A, Brennen K, Barclay S, Shackleford T, Samuels P . Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial. Paediatr Anaesth. 2009; 19(8):748-55. DOI: 10.1111/j.1460-9592.2009.03054.x. View

20.

Uezono S, Goto T, Terui K, Ichinose F, Ishguro Y, Nakata Y . Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg. 2000; 91(3):563-6. DOI: 10.1097/00000539-200009000-00012. View