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Subanesthetic-dose propofol infusion for preventing emergence agitation in children: a retrospective observational

Tomoaki Miyake1,2, Yoshihisa Miyamoto3,4, Nobuhito Nakamura1

  • 1Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan.

Journal of Anesthesia
|May 15, 2023
PubMed

Insights

Subanesthetic propofol infusion during sevoflurane anesthesia significantly reduced emergence agitation (EA) in children undergoing surgery. This anesthesia method offers a promising strategy to prevent EA, decreasing the need for additional medications.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Emergence agitation (EA) is a common complication following general anesthesia in children.
  • Propofol administration, either as maintenance or a bolus dose, has demonstrated efficacy in preventing EA.
  • The impact of subanesthetic propofol infusion during sevoflurane anesthesia on EA in pediatric patients remains under investigation.

Purpose of the Study:

  • To evaluate the effectiveness of subanesthetic propofol infusion combined with sevoflurane anesthesia in preventing severe emergence agitation (EA) in children.
  • To compare the incidence of EA between children receiving sevoflurane alone versus those receiving a combination of sevoflurane and subanesthetic propofol.

Main Methods:

  • A retrospective study comparing two groups of pediatric patients undergoing specific surgeries (adenoidectomy, tonsillectomy, strabismus surgery).
  • Group 1 received sevoflurane alone for anesthesia maintenance.
  • Group 2 received a combination of sevoflurane and subanesthetic propofol infusion.
  • Multivariable logistic regression and mediation analysis were employed to assess the association between anesthesia methods and EA incidence, adjusting for confounders.

Main Results:

  • The study included 244 children, with 132 in the sevoflurane group and 112 in the combination group.
  • The incidence of severe EA was significantly lower in the combination group (17.0%) compared to the sevoflurane group (33.3%) (P=0.005).
  • Adjusted analysis confirmed a significantly lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.25-0.91), with mediation analysis showing a direct effect of the anesthesia method.

Conclusions:

  • Subanesthetic propofol infusion during sevoflurane anesthesia is an effective strategy for preventing severe emergence agitation (EA) in pediatric patients.
  • This anesthesia approach reduces the need for pharmacological interventions like opioids or sedatives to manage EA.
  • The findings suggest a valuable role for combined sevoflurane and subanesthetic propofol in pediatric anesthesia to improve emergence outcomes.
Abstract

Keywords:
ChildEmergence deliriumMediation analysisSubanaesthetic-dose propofol

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