Top

Journal of Anesthesia

Published in:

01-02-2014 | Original Article

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

Authors: Akihiro Kanaya, Norifumi Kuratani, Daizoh Satoh, Shin Kurosawa

Published in: Journal of Anesthesia | Issue 1/2014

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.

Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004;100:1138–45.PubMedCrossRef

Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth. 2000;10:419–24.PubMedCrossRef

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;109:225–32.PubMedCrossRef

Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia. Anesth Analg. 2000;90:168–74.PubMedCrossRef

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. 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:e1–34.PubMedCrossRef

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.PubMedCrossRef

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.PubMedCrossRef

Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320:1574–7.PubMedCrossRef

Tang J, Chen L, White PF, Watcha MF, Wender RH, Naruse R, Kariger R, Sloninsky A. Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology. 1999;91:253–61.PubMedCrossRef

10.

Kol IO, 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;30:175–81.PubMedCrossRef

11.

Hanna MG, Said HA. Comparison of two rapid recovery anaesthetic techniques using propofol versus sevoflurane in adjustable strabismus surgery. Egypt J Anaesth. 2004;20:59–62.

12.

Guard BC, Sikich N, Lerman J, Levine M. Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade. Can J Anaesth. 1998;45:1072–8.PubMedCrossRef

13.

Lopéz Gil ML, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth. 1999;9:485–90.PubMedCrossRef

14.

Gürkan Y, Kiliçkan L, Toker K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth. 1999;9:495–9.PubMedCrossRef

15.

Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand. 2000;44:307–10.PubMedCrossRef

16.

Uezono S, Goto T, Terui K, Ichinose F, Ishguro Y, Nakata Y, Morita S. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg. 2000;91:563–6.PubMedCrossRef

17.

Koçak ÖZ, Altunkan AA, Atici S, Cinel I, Oral U. Comparison of remifentanil-propofol and sevoflurane for preventing cardiovascular response and quality of recovery in paediatric otolaryngologic surgery. Turk J Med Sci. 2001;31:559–64.

18.

Kubo S, Kinouchi K, Taniguchi A, Fukumitsu K, Kitamura S. Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia. Masui. 2001;50:371–7 (in Japanese).PubMed

19.

Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth. 2003;13:63–7.PubMedCrossRef

20.

Auerswald K, Behrends K, Burkhardt U, Olthoff D. Propofol for paediatric patients in ear, nose and throat surgery. Practicability, quality and cost-effectiveness of different anaesthesia procedures for adenoidectomy in infants. Anaesthesist. 2006;55:846–53 (in German).PubMedCrossRef

21.

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;21:19–23.PubMedCrossRef

22.

Bryan YF, Hoke LK, Taghon TA, Nick TG, Wang Y, Kennedy SM, Furstein JS, Kurth CD. A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth. 2009;19:672–81.PubMedCrossRef

23.

König MW, Varughese AM, Brennen KA, Barclay S, Shackleford TM, Samuels PJ, Gorman K, Ellis J, Wang Y, Nick TG. Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial. Paediatr Anaesth. 2009;19:748–55.PubMedCrossRef

24.

Deng XQ, 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;27:531–4 (in Chinese).PubMed

25.

Pieters BJ, Penn E, Nicklaus P, Bruegger D, Mehta B, Weatherly R. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs. sevoflurane anesthesia. Paediatr Anaesth. 2010;20:944–50.PubMedCrossRef

26.

Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004;98:632–41.PubMedCrossRef

27.

Komatsu H, Taie S, Endo S, Fukuda K, Ueki M, Nogaya J, Ogli K. Electrical seizures during sevoflurane anesthesia in two pediatric patients with epilepsy. Anesthesiology. 1994;81:1535–7.PubMedCrossRef

28.

Woodforth IJ, Hicks RG, Crawford MR, Stephen JP, Burke DJ. Electroencephalographic evidence of seizure activity under deep sevoflurane anesthesia in a nonepileptic patient. Anesthesiology. 1997;87:1579–82.PubMedCrossRef

29.

Welborn LG, Hannallah RS, Norden JM, Ruttimann UE, Callan CM. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg. 1996;83:917–20.PubMed

30.

Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, Nivoche Y, Constant I, Murat I. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216–23.PubMedCrossRef

31.

Oh AY, Seo KS, Kim SD, Kim CS, Kim HS. Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children. Acta Anaesthesiol Scand. 2005;49:297–9.PubMedCrossRef

32.

Mehta N, DeMunter C, Habibi P, Nadel S, Britto J. Short-term propofol infusions in children. Lancet. 1999;354:866–7.PubMedCrossRef

33.

Kill C, Leonhardt A, Wulf H. Lactic acidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta. Paediatr Anaesth. 2003;13:823–6.PubMedCrossRef

Title: Lower incidence of emergence agitation in children after propofol anesthesia compared with sevoflurane: a meta-analysis of randomized controlled trials
Authors: Akihiro Kanaya
Norifumi Kuratani
Daizoh Satoh
Shin Kurosawa
Publication date: 01-02-2014
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 1/2014
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-013-1656-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

To assess the changes of tracheal cuff pressure after a calibrating orogastric tube insertion

Perfusion index as a possible predictor for postanesthetic shivering

Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair

In response to Goyal R, et al. J Anesth, Dec. 9 (2012)

Postcraniotomy headache

Intravenous lipid rescue and ropivacaine systemic toxicity