Safety of Propofol versus Sevoflurane for Children's Surgery: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 PENGHan-fei ,  ZOUYuan , LIZhen , ZHUYa-ping

Department of Anesthesiology, Haiyan Hospital of Traditional Chinese Medicine in Zhejiang, Jiaxing 314300, China;

Corresponding author：

ZOUYuan, Email: zouyuant@163.com

Keywords：

Propofol; Sevoflurane; Children's surgery; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20160182

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Objective To systematically review the safety of propofol versus sevoflurane for pediatric surgery. Methods EMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software. Results Fifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16). Conclusion In reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.

Citation： PENGHan-fei, ZOUYuan, LIZhen, ZHUYa-ping. Safety of Propofol versus Sevoflurane for Children's Surgery: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1201-1206. doi: 10.7507/1672-2531.20160182 Copy

1.	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): 225-232.
2.	Kumar G, Stendall C, Mistry R, et al. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Anaesthesia, 2014, 69(10): 1138-1150.
3.	Jellish WS, Lien CA, Fontenot HJ, et al. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adult patients. Anesth Analg, 1996, 82(3): 479-485.
4.	Guard BC, Sikich N, Lerman J, et al. Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade. Can J Anaesth, 1998, 45(11): 1072-1078.
5.	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(6): 485-490.
6.	Gürkan Y, Kiliçkan L, Toker K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9(6): 495-499.
7.	Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
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.	Kocak OZ, Altunkan AA, Atici S, et al. Comparison of remifentanil-propofol and sevoflurane for preventing cardiovascular response and quality of recovery in paediatric otolaryngologic surgery. Turk J Med Sci, 2001, 31(1): 559-564.
10.	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.
11.	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.
12.	Auerswald K, Behrends K, Burkhardt U, et al. 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(8): 846-853.
13.	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.
14.	König 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.
15.	邓晓倩, 王淼, 吉阳. 异丙酚、瑞芬太尼和七氟烷、瑞芬太尼用于小儿唇腭裂手术麻醉的临床观察. 华西口腔医学杂志, 2009, 27(5): 531-534.
16.	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.
17.	Hasani A, Gecaj-Gashi A, Llullaku S, et al. Postoperative analgesia in children after propofol versus sevoflurane anesthesia. Pain Med, 2013, 14(3): 442-446.
18.	Yin J, Wang SL, Liu XB. The effects of general anaesthesia on memory in children: a comparison between propofol and sevoflurane. Anaesthesia, 2014, 69(2): 118-123.
19.	Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011, 342: d1110.
20.	Rajan S, Gotluru P, Andews S, et al. Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries. J Anaesthesiol Clin Pharmacol, 2014, 30(3): 360-365.

1. 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): 225-232.
2. Kumar G, Stendall C, Mistry R, et al. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Anaesthesia, 2014, 69(10): 1138-1150.
3. Jellish WS, Lien CA, Fontenot HJ, et al. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adult patients. Anesth Analg, 1996, 82(3): 479-485.
4. Guard BC, Sikich N, Lerman J, et al. Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade. Can J Anaesth, 1998, 45(11): 1072-1078.
5. 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(6): 485-490.
6. Gürkan Y, Kiliçkan L, Toker K. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9(6): 495-499.
7. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
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. Kocak OZ, Altunkan AA, Atici S, et al. Comparison of remifentanil-propofol and sevoflurane for preventing cardiovascular response and quality of recovery in paediatric otolaryngologic surgery. Turk J Med Sci, 2001, 31(1): 559-564.
10. 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.
11. 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.
12. Auerswald K, Behrends K, Burkhardt U, et al. 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(8): 846-853.
13. 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.
14. König 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.
15. 邓晓倩, 王淼, 吉阳. 异丙酚、瑞芬太尼和七氟烷、瑞芬太尼用于小儿唇腭裂手术麻醉的临床观察. 华西口腔医学杂志, 2009, 27(5): 531-534.
16. 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.
17. Hasani A, Gecaj-Gashi A, Llullaku S, et al. Postoperative analgesia in children after propofol versus sevoflurane anesthesia. Pain Med, 2013, 14(3): 442-446.
18. Yin J, Wang SL, Liu XB. The effects of general anaesthesia on memory in children: a comparison between propofol and sevoflurane. Anaesthesia, 2014, 69(2): 118-123.
19. Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011, 342: d1110.
20. Rajan S, Gotluru P, Andews S, et al. Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries. J Anaesthesiol Clin Pharmacol, 2014, 30(3): 360-365.

Chinese Journal of Evidence-Based Medicine

Safety of Propofol versus Sevoflurane for Children's Surgery: A Meta-analysis

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