Emergence and Recovery Characteristics of Five Common Anesthetics in Pediatric Anesthesia: a Network Meta-analysis

Abstract

Desflurane, halothane, isoflurane, propofol, and sevoflurane are widely used anesthetics in pediatric anesthesia. Adverse effect including emergence agitation, postoperative nausea and vomiting, and postoperative pain are common. Prolonged extubation time and emergency time are also troubling anesthesiologists. Previous studies have noted the characteristics of various anesthetics in pediatric anesthesia, while the results were inconclusive and conflicting. In this study, we aimed at performing a comprehensive network meta-analysis concerning the emergence and recovery characteristics of pediatric anesthetics. Relevant articles were retrieved and selected according to our inclusion criteria. Network meta-analysis was performed with a random-effect model within a Bayesian framework. ORs and corresponding 95 % credible intervals were calculated by Markov chain Monte Carlo methods. Node-splitting method was used to calculate the inconsistency. Rank probabilities were assessed by the surface under the cumulative ranking curve (SUCRA). Propofol was recommended as the most efficient and safe anesthetic in pediatric anesthesia with few adverse effects. Desflurane has the highest incidence of emergence agitation and worst recovery characteristics. Halothane was regarded as an efficient anesthetic with the best recovery characteristics, while postoperative nausea and vomiting is a common adverse effect. Isoflurane was reported to be the safest concerning postoperative pain, and cases using sevoflurane in pediatric anesthesia reported the highest incidence of analgesic requirement. Our network meta-analysis demonstrated that propofol was suggested as the first choice in the clinical practice for its efficiency and safe in pediatric anesthesia.

The General Anesthetic Isoflurane Bilaterally Modulates Neuronal Excitability

“…Here, isoflurane at sub-anesthetic concentration induced hyperactivity in vivo. This is consistent with previous studies that sevoflurane can induce hyperactivity during induction and recovery (Costi et al, 2014;Guo et al, 2017;Liang et al, 2017). The isoflurane-induced hyperactivity was completely diminished in NALCN knockdown mice in vivo.…”

“…during anesthesia induction and recovery (Dahmani et al, 2010;Guo et al, 2017;Liang et al, 2017) and immobility at higher concentrations (Sonner et al, 2003). A variety of neuronal functions are bidirectionally modulated by volatile anesthetics (Chen et al, 2018;Yu et al, 2015;MacIver andRoth, 1987, 1988).…”

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

“…The reasons for this discrepancy included the differences in the numbers of included studies and the participants undergoing different types of surgery, which involved different premedication types and the use of different tools to assess EA incidence. Moreover, in a recent study on desflurane, halothane, isoflurane, propofol, and sevoflurane in pediatric anesthesia, desflurane led to the highest EA incidence [32]. Our results indicated that dexmedetomidine use considerably decreased the EA incidence when patient received sevoflurane or desflurane.…”

The Evaluation of the Factors Affecting Emergence Agitation in Pediatric Anesthesia Practise

“…In a meta-analysis, Guo et al [10] investigated the effects of propofol, desflurane, halothane, isoflurane, and sevoflurane on agitation and recovery in pediatric cases, and recommended propofol as the most effective and safest anesthetic agent to provide pediatric anesthesia. Desflurane was reported to have the greatest incidence of agitation and the most difficult recovery characteristics.…”