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The efficacy of propofol on emergence agitation--a meta-analysis of randomized controlled trials
1Division of Anesthesiology, Department of Cardiovascular Surgery, Guangdong Institute of Cardiovascular, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
Insights
Adjunctive propofol significantly reduces emergence agitation in pediatric patients after sevoflurane and desflurane anesthesia. However, further research is needed due to study limitations and heterogeneity.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
Background:
- Emergence agitation (EA) is a frequent complication in children post-anesthesia.
- Sevoflurane and desflurane anesthesia are commonly associated with EA.
- Identifying effective interventions to mitigate EA is crucial for pediatric patient care.
Purpose of the Study:
- To evaluate the efficacy of an additional dose of propofol in decreasing the incidence of EA.
- To synthesize evidence from existing clinical trials on propofol's effect on EA in pediatric patients.
- To determine if propofol reduces EA in children undergoing sevoflurane or desflurane anesthesia.
Main Methods:
- A systematic literature review and meta-analysis of relevant clinical trials.
- Searched multiple databases including MEDLINE, EMBASE, Web of Science, and CNKI.
- Calculated pooled relative ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).
- Assessed heterogeneity, publication bias, and used Lan-DeMets sequential monitoring boundaries.
Main Results:
- Adjunctive propofol demonstrated a significant preventive effect against EA (RR = 0.56; 95% CI = 0.43-0.74; P < 0.0001).
- No significant difference was observed in post-anesthesia care unit stay duration between groups (MD = 0.25 min; 95% CI = -2.81 to 2.31).
- The analysis met the required information size, but included studies had high risk of bias and significant heterogeneity.
Conclusions:
- Adjunctive propofol shows promise in reducing emergence agitation in pediatric patients.
- High risk of bias and heterogeneity in current studies necessitate cautious interpretation of findings.
- Further high-quality research is required to confirm the benefits of adjunct propofol for EA prevention.
Background:
Emergence agitation (EA) is a common, post-anesthetic complication in pediatric patients following sevoflurane and desflurane anesthesia. The aim of this meta-analysis was to assess the effects of an adjunctive dose of propofol to reduce the incidence of EA in pediatric patients.
Methods:
A comprehensive literature review was conducted to identify clinical trials focusing on the effects of propofol on EA in children under sevoflurane and desflurane anesthesia. The MEDLINE, EMBASE, Wiley Online Library, Web of Science, China National Knowledge Internet databases, and other sources were searched. The data were combined to calculate the pooled relative ratio (RR) or mean difference (MD), and relevant 95% confidence interval (CI). Heterogeneity and potential publication bias were assessed. The required information size was calculated and a Lan-DeMets sequential monitoring boundary was constructed to improve the precision of our findings.
Results:
Data from 11 studies showed that an adjunctive dose of propofol conveyed a preventive effect on EA, as compared with placebo (RR = 0.56; 95% CI = 0.43-0.74; P < 0.0001). There was no significant difference in the length of stay in the post-anesthesia care unit between groups (MD = 0.25 min; 95% CI = -2.81 to 2.31; P = 0.85). The required information size was 2297 patients and the Lan-DeMets sequential monitoring boundary was crossed. However, most of the included studies had a high risk of bias and non-ignorable inter-study and clinical heterogeneity.
Conclusion:
Future studies on the benefits of adjunct propofol in reducing the incidence of EA are required.
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