Emergence and Recovery Characteristics of Five Common Anesthetics in Pediatric Anesthesia: a Network Meta-analysis

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Common adverse effects in pediatric anesthesia include emergence agitation, nausea, vomiting, and pain.
• Prolonged extubation and emergence times are significant concerns for anesthesiologists.
• Previous studies on anesthetic characteristics in pediatric patients yielded inconclusive and conflicting results.

Purpose of the Study:

• To conduct a comprehensive network meta-analysis on the emergence and recovery characteristics of various anesthetics used in pediatric anesthesia.
• To compare the safety and efficacy profiles of desflurane, halothane, isoflurane, propofol, and sevoflurane.
• To provide evidence-based recommendations for anesthetic selection in pediatric patients.

Main Methods:

• A systematic search and selection of relevant articles were performed.
• A random-effect model within a Bayesian framework was utilized for network meta-analysis.
• Markov chain Monte Carlo methods calculated odds ratios and credible intervals; node-splitting assessed inconsistency; SUCRA ranked agents.

Main Results:

• Propofol demonstrated the best safety and efficiency profile with minimal adverse effects.
• Desflurane was associated with the highest incidence of emergence agitation and poorest recovery.
• Halothane offered efficient anesthesia with favorable recovery but increased postoperative nausea and vomiting; Isoflurane was safest for postoperative pain; Sevoflurane correlated with higher analgesic requirements.

Conclusions:

• Propofol is recommended as the preferred anesthetic in pediatric practice due to its favorable efficacy and safety profile.
• Anesthetic choice should consider specific patient needs and potential adverse effects, with propofol emerging as a leading option.
• This meta-analysis provides valuable insights for optimizing anesthetic management in pediatric patients.