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Effect of Intravenous, Inhalational, or Combined Anesthesia Maintenance on Postoperative Respiratory Adverse Events

Fangming Shen1, Li Zhang2, Xinghe Wang3

  • 1Department of Anesthesiology, Surgery, and Pain Management and Key Laboratory of Clinical Science and Research, Zhongda Hospital Southeast University, Southeast University School of Medicine, Nanjing, China.

Anesthesiology
|August 6, 2025
PubMed

Insights

Propofol-based anesthesia significantly reduces postoperative respiratory adverse events in children undergoing adenotonsillectomy. Intravenous propofol alone was most effective, followed by combined intravenous-inhalation methods, compared to inhalation anesthesia alone.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Respiratory Medicine

Background:

  • Postoperative respiratory adverse events (PRAEs) are a concern in pediatric anesthesia.
  • The impact of anesthesia maintenance strategies on PRAEs requires further validation.
  • This study investigates propofol-based anesthesia maintenance for reducing PRAEs in children.

Purpose of the Study:

  • To evaluate the effectiveness of different anesthesia maintenance strategies on PRAEs incidence in children.
  • To test the hypothesis that propofol infusion reduces PRAEs compared to inhalation anesthesia.
  • To compare intravenous (IV), combined intravenous-inhalation (IVIH), and inhalation (IH) anesthesia maintenance for adenotonsillectomy.

Main Methods:

  • Multicenter randomized clinical trial (AmPRAEC study) involving 760 children (0-12 years).
  • Random assignment to IV, IVIH, or IH anesthesia maintenance groups.
  • Primary outcome: PRAEs incidence in the post-anesthesia care unit; awake extubation used.

Main Results:

  • The IV group showed the lowest PRAEs incidence (18.8%), followed by IVIH (28.5%) and IH (43.4%).
  • Compared to IH, IVIH significantly reduced PRAEs risk (aOR: 0.44; NNT: 7).
  • The IV group demonstrated significantly lower PRAEs risk than both IVIH (aOR: 0.57; NNT: 6) and IH (aOR: 0.25; NNT: 3).

Conclusions:

  • Anesthesia maintenance with propofol infusion, alone or combined, progressively reduced PRAEs incidence.
  • Propofol intravenous anesthesia maintenance is recommended for children undergoing adenotonsillectomy.
  • These findings support propofol-based anesthesia for improved pediatric respiratory outcomes post-surgery.
Abstract

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