Impacts of General Anesthesia Using Sevoflurane versus Propofol on Emergence Agitation in Pediatric Patients: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Haijun ,  LI Yulan , SUN Rao , LIU Jingjing

Anesthesiology Department, The First Clinical College of Medicine, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LI Yulan, Email: easttale@gmail.com

Keywords：

Sevoflurane; Propofol; General anesthesia; Children; Agitation; Delirium; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130234

Video：

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Objective 　To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients.
Methods 　Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software.
Results 　A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, P lt;0.000 1).
Conclusion 　The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.

Citation： ZHANG Haijun,LI Yulan,SUN Rao,LIU Jingjing. Impacts of General Anesthesia Using Sevoflurane versus Propofol on Emergence Agitation in Pediatric Patients: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(11): 1367-1372. doi: 10.7507/1672-2531.20130234 Copy

1.	Dahmani S, Stany I, Brasher C, et al. 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.
2.	Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction: A meta-analysis. Anesthesia and Analgesia, 2000, 91(1): 213-219.
3.	Kuratani N. Emergence agitation in pediatric anesthesia. Masui, 2007, 56(5): 554-559.
4.	Konig MW, Varughese AM, Brennen KA, et al. 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): 748-755.
5.	Pieters BJ, Penn E, Nicklaus P, et al. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth, 2010, 20(10): 944-950.
6.	Bryan YF, Hoke LK, Taghon TA, et al. A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth, 2009, 19(7): 672-681.
7.	Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
8.	Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
9.	Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
10.	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.
11.	Kol IO, Egilmez H, Kaygusuz K, et al. 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): 175-181.
12.	Lopez 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(6): 485-490.
13.	Bayindir O, Akpinar B, Can E, et al. The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth, 2000, 14(3): 288-292.
14.	Kim, JH. Mechanism of emergence agitation induced by sevoflurane anesthesia. Korean J Anesthesiol, 2011, 60(2): 73-74.
15.	Lankinen U, Avela R, Tarkkila P. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy. Anesth Analg, 2006, 102(5): 1383-1386.
16.	Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry, 2000, 61(Suppl 14): 5-10.
17.	Eom W, Lee JM, Park J, et al. The effects of midazolam and sevoflurane on the GABA(A) receptors with alternatively spliced variants of the gamma2 subunit. Korean J Anesthesiol, 2011, 60(2): 109-118.
18.	Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth, 2008, 18(1): 55-59.
19.	Aouad MT, Yazbeck-Karam VG, Nasr VG, et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology, 2007, 107(5): 733-738.
20.	Kim MS, Moon BE, Kim H, et al. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth, 2013, 110(2): 274-280.
21.	Kim YH, Yoon SZ, Lim HJ, et al. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care, 2011, 39(5): 904-908.
22.	Lee CJ, Lee SE, Oh MK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol, 2010, 59(2): 75-81.
23.	Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth, 2007, 17(9): 846-850.
24.	Malviya S, Voepel-Lewis T, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth, 2006, 16(5): 554-559.
25.	Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367.
26.	Breschan C, Platzer M, Jost R, et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Paediatr Anaesth, 2007, 17(4): 347-352.
27.	Bae JH, Koo BW, Kim SJ, et al. The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery. Korean J Anesthesiol, 2010, 58(1): 45-49.
28.	Kubo S, Kinouchi K, Taniguchi A, et al. Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia. Masui, 2001, 50(4): 371-377.

1. Dahmani S, Stany I, Brasher C, et al. 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.
2. Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction: A meta-analysis. Anesthesia and Analgesia, 2000, 91(1): 213-219.
3. Kuratani N. Emergence agitation in pediatric anesthesia. Masui, 2007, 56(5): 554-559.
4. Konig MW, Varughese AM, Brennen KA, et al. 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): 748-755.
5. Pieters BJ, Penn E, Nicklaus P, et al. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth, 2010, 20(10): 944-950.
6. Bryan YF, Hoke LK, Taghon TA, et al. A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth, 2009, 19(7): 672-681.
7. Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
8. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
9. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
10. 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.
11. Kol IO, Egilmez H, Kaygusuz K, et al. 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): 175-181.
12. Lopez 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(6): 485-490.
13. Bayindir O, Akpinar B, Can E, et al. The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth, 2000, 14(3): 288-292.
14. Kim, JH. Mechanism of emergence agitation induced by sevoflurane anesthesia. Korean J Anesthesiol, 2011, 60(2): 73-74.
15. Lankinen U, Avela R, Tarkkila P. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy. Anesth Analg, 2006, 102(5): 1383-1386.
16. Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry, 2000, 61(Suppl 14): 5-10.
17. Eom W, Lee JM, Park J, et al. The effects of midazolam and sevoflurane on the GABA(A) receptors with alternatively spliced variants of the gamma2 subunit. Korean J Anesthesiol, 2011, 60(2): 109-118.
18. Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth, 2008, 18(1): 55-59.
19. Aouad MT, Yazbeck-Karam VG, Nasr VG, et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology, 2007, 107(5): 733-738.
20. Kim MS, Moon BE, Kim H, et al. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth, 2013, 110(2): 274-280.
21. Kim YH, Yoon SZ, Lim HJ, et al. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care, 2011, 39(5): 904-908.
22. Lee CJ, Lee SE, Oh MK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol, 2010, 59(2): 75-81.
23. Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth, 2007, 17(9): 846-850.
24. Malviya S, Voepel-Lewis T, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth, 2006, 16(5): 554-559.
25. Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367.
26. Breschan C, Platzer M, Jost R, et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Paediatr Anaesth, 2007, 17(4): 347-352.
27. Bae JH, Koo BW, Kim SJ, et al. The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery. Korean J Anesthesiol, 2010, 58(1): 45-49.
28. Kubo S, Kinouchi K, Taniguchi A, et al. Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia. Masui, 2001, 50(4): 371-377.

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Impacts of General Anesthesia Using Sevoflurane versus Propofol on Emergence Agitation in Pediatric Patients: A Systematic Review

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