The effects of alfentanil on emergence agitation in children under general anesthesia: a meta-analysis of randomized

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Yuanling Xu1, Kun Ding1, Xuemei Zhao1

  • 1Department of Anaesthesiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China.

Frontiers in Pediatrics
|October 27, 2025
PubMed

Insights

Alfentanil significantly reduces emergence agitation (EA) in children after general anesthesia. This meta-analysis found alfentanil lowered EA incidence and the need for rescue analgesia, with moderate evidence quality.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Emergence agitation (EA) is a common complication in children post-general anesthesia, characterized by heightened reactivity and sensory impairment.
  • Alfentanil, a short-acting µ-opioid agonist, is frequently used in pediatric minor surgeries.

Purpose of the Study:

  • To conduct a meta-analysis assessing the efficacy of alfentanil in reducing the incidence of emergence agitation in pediatric patients undergoing general anesthesia.

Main Methods:

  • A systematic review of PubMed, Cochrane Library, Embase, and Web of Science databases was performed for trials published up to April 30, 2025.
  • The primary outcome was the incidence of EA, with secondary outcomes including rescue analgesia, PONV, and emergence-related times.
  • Data from 5 studies involving 532 patients were analyzed.

Main Results:

  • Alfentanil significantly decreased the incidence of EA in children compared to saline (RR=0.54; 95% CI: 0.42-0.70; P<0.01).
  • The use of rescue analgesia was also reduced with alfentanil administration (RR=0.5; 95% CI: 0.38-0.65; P<0.01).
  • Alfentanil did not significantly increase the incidence of postoperative nausea and vomiting (PONV) (RR=1.39; 95% CI: 0.67-2.88; P=0.37).

Conclusions:

  • Available evidence suggests alfentanil is effective in lowering the incidence of EA in pediatric patients.
  • Moderate quality evidence supports the use of alfentanil for preventing EA.
  • Further high-quality research is warranted to confirm these findings and optimize its use in pediatric anesthesia.
Abstract

Keywords:
alfentanilemergence agitationgeneral anesthesiapediatricreview

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