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μ-Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: a meta-analysis of
Yuan Tan1, Yisa Shi1, Hui Ding2
1Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China.
Insights
Prophylactic μ-opioid agonists like fentanyl can significantly reduce emergence agitation in children after sevoflurane anesthesia. This meta-analysis confirms their effectiveness, though further research is recommended.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Emergence agitation (EA) is a common adverse event in pediatric patients following sevoflurane anesthesia.
- The efficacy of prophylactic μ-opioid agonists in preventing EA remains a subject of debate.
Purpose of the Study:
- To systematically evaluate the effectiveness of prophylactic μ-opioid agonists (fentanyl, remifentanil, sufentanil, alfentanil) in preventing emergence agitation in pediatric patients undergoing sevoflurane anesthesia.
Main Methods:
- A meta-analysis of 19 randomized controlled trials involving 1528 pediatric patients.
- Data were analyzed using relative ratios and weighted mean differences, with heterogeneity assessed by I(2).
- Subgroup analyses explored factors influencing EA prevention, and publication bias was examined.
Main Results:
- Prophylactic administration of fentanyl, remifentanil, sufentanil, and alfentanil significantly decreased the incidence of EA compared to placebo.
- Fentanyl demonstrated a notable reduction in EA incidence (RR = 0.49).
- Subgroup analyses supported fentanyl's efficacy, although potential publication bias was noted.
Conclusions:
- Prophylactic μ-opioid agonists, including fentanyl, remifentanil, sufentanil, and alfentanil, are effective in reducing the incidence of emergence agitation in children under sevoflurane anesthesia.
- Further clinical studies are warranted to address the limitations of the current evidence.
Background:
Emergence agitation (EA) is an adverse effect after sevoflurane anesthesia in pediatric patients. The effectiveness of prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil in preventing EA is debatable.
Methods:
A literature search was conducted to identify clinical trials that observed the effect of μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil on preventing EA in pediatric patients under sevoflurane anesthesia. The statistical software RevMan 5.3 was used for meta-analysis. Data from each study were combined using the relative ratio (RR), weighted mean differences, and their associated 95% confidence intervals. I(2) was used to evaluate heterogeneity. Subgroup analysis was conducted to investigate the possible influences of patient age, adenotonsillectomy, premedication, N2 O, propofol, and regional block/local anesthetics on preventing EA with prophylactic administration of μ-opioid agonists. Publication bias was checked using funnel plots and Begg's test.
Results:
This meta-analysis showed the inclusion of 19 randomized controlled trials with 1528 patients (857 patients received μ-opioid agonists therapy and 671 patients had placebo). The pooled data indicated that prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil significantly decreased the incidence of EA [RR = 0.49 (0.38, 0.64), I(2) = 42%, P = 0.04; RR = 0.57 (0.33, 0.99), I(2) = 37%, P = 0.19; RR = 0.18 (0.08, 0.39), I(2) = 0%, P = 0.98; and RR = 0.56 (0.40, 0.78), I(2) = 6%, P = 0.34, respectively]. All subgroup analyses strengthened the proof for lower incidence of EA under sevoflurane anesthesia after fentanyl administration. A possibility of publication bias was detected in the fentanyl group.
Conclusions:
This meta-analysis suggested that prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil could significantly decrease the incidence of EA under sevoflurane anesthesia in children compared to placebo. Considering the limitations of the included studies, more clinical studies are required.
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