Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials

Kanaya, Akihiro; Kuratani, Norifumi; Satoh, Daizoh; Kurosawa, Shin

doi:10.1007/s00540-013-1656-y

Cited by 80 publications

(67 citation statements)

References 29 publications

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“…The results were confirmed in our analysis. It has also been demonstrated by Kanaya et al in their analysis that emergence agitation in children is less likely to occur after propofol anesthesia compared with sevoflurane anesthesia [60]. Similar results were also reported by Costi et al [61] There is also a meta-analysis revealing that emergence agitation occurred more frequently with sevoflurane than with halothane anesthesia in children [62].…”

Section: Discussionsupporting

confidence: 55%

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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 55%

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

et al. 2016

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“…Sevoflurane is associated with a high incidence of EA, and there is a general agreement amongst anesthetists that sevoflurane can increase the incidence of EA in the recovery stage in children compared to propofol [3]–[5]. Meta-analysis confirmed that EA occurs more frequently in children under sevoflurane anesthesia than under propofol anesthesia [26]. In addition, another meta-analysis demonstrated that EA occurs more frequently under sevoflurane anesthesia than under halothane anesthesia [5].…”

Section: Discussionmentioning

confidence: 95%

“…The low blood–gas solubility and rapid recovery characteristics of sevoflurane may contribute to EA [29]–[34]. In a meta-analysis of Kanaya et al [26] showed that the incidence of EA is higher under sevoflurane anesthesia than that under propofol anesthesia in children, extubation time in propofol group was slightly longer (WMD = 1.09 min, 95% CI 0.096 to 2.09), however, because of the significant data heterogeneity, it is difficult to confirm whether rapid emergence plays a role in the higher incidence of EA after sevoflurane anesthesia. In our findings that children administered dexmedetomidine had slightly prolonged extubation time, and emergence time (WMD = 0.617 min, 95% CI 0.276 to 0.958, and WMD = 0.997 min, 95% CI 0.392 to 1.561 respectively), and lower incidence of EA.…”

Section: Discussionmentioning

confidence: 99%

Effects of Intravenous Dexmedetomidine on Emergence Agitation in Children under Sevoflurane Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Zhang

Liu

et al. 2014

PLoS ONE

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ObjectiveEmergence agitation (EA) is a common complication in children under sevoflurane anesthesia. The aim of this meta-analysis was to evaluate the effects of intravenous dexmedetomidine on EA in children under sevoflurane anesthesia.MethodsA comprehensive literature search was conducted to identify clinical trials that evaluated the effects of intravenous dexmedetomidine and placebo on EA in children under sevoflurane anesthesia. The search collected trials from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Analysis was conducted using STATA version 12.0. Data from each trial were pooled using relative ratio (RR) for dichotomous data or weighted mean difference (WMD) for continuous data and corresponding 95% confidence interval (95% CI). Heterogeneity assessment, sensitivity analysis, and publication bias were performed.ResultsTwelve trials, in which 459 patients received dexmedetomidine and 353 patients received placebo, were included in this analysis. We found that intravenous dexmedetomidine decreased the incidences of EA (RR = 0.346, 95% CI 0.263 to 0.453, P<0.001), and postoperative pain (RR = 0.405, 95% CI 0.253 to 0.649, P<0.001). Intravenous dexmedetomidine also prolonged extubation time (WMD = 0.617, 95% CI 0.276 to 958, P<0.001), and emergence time (WMD = 0.997, 95% CI 0.392 to 1.561, P = 0.001). Further evidences are required to evaluate the incidence of postoperative nausea and vomiting (PONV). Sensitivity analysis strengthened evidences for lower incidences of EA, pain, and prolonged extubation time, and emergence time. Funnel plots did not detect any significant publication bias.ConclusionMeta-analysis demonstrated that dexmedetomidine decreased the incidence of EA in children under sevoflurane anesthesia.

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“…In most studies that have compared propofol infusions with sevoflurane, opioids have been added to the propofol arm, thus making interpretation difficult. However, a recent meta-analysis has shown a much lower incidence of emergence delirium with propofol compared with sevoflurane [27], and even if the anaesthetic was sevofluranebased, a single dose of 1 mg.kg…”

mentioning

confidence: 99%

Emergence delirium in children

Wong

Bailey

2015

Anaesthesia

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Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials

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

Cited by 80 publications

References 29 publications

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

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

Effects of Intravenous Dexmedetomidine on Emergence Agitation in Children under Sevoflurane Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Emergence delirium in children

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