Related Experiment Video
Updated: Aug 14, 2026
11:19
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pre-Extubation Low-Dose Propofol in Pediatric Ear, Nose, and Throat Procedures: A Meta-Analysis With Trial Sequential
Rafaela Silva1, Raphaela Mendes2, João Mario Borges3
1Department of Medicine, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Paediatric Anaesthesia
|August 12, 2026
Summary
Low-dose propofol before extubation likely reduces emergence agitation (EA) in pediatric ENT surgery. While evidence for reduced agitation severity is very low, moderate evidence supports its use for lowering EA incidence.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Post-extubation emergence agitation (EA) is a frequent complication in pediatric ear, nose, and throat (ENT) procedures.
- EA can lead to significant adverse events and complications.
Purpose of the Study:
- To evaluate the effectiveness of low-dose propofol administered prior to extubation in preventing EA in pediatric ENT surgery.
- A meta-analysis with trial sequential analysis (TSA) was employed to assess efficacy compared to placebo.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Cochrane).
- Included were randomized controlled trials (RCTs) comparing low-dose propofol with placebo before extubation in pediatric ENT procedures.
- Primary outcomes included laryngospasm, EA severity (PAED scale), and EA incidence; secondary outcomes assessed recovery and PACU stay.
Main Results:
- Meta-analysis of six RCTs (414 patients) showed propofol significantly reduced EA incidence (RR 0.57) and severity (MD -3.94).
- Time to extubation was slightly prolonged (MD 1.8 min), but recovery time and PACU length of stay did not differ significantly.
- TSA confirmed findings for EA incidence and time to extubation, though evidence certainty varied (moderate for incidence, very low for severity).
Conclusions:
- Pre-extubation low-dose propofol likely decreases EA incidence in pediatric ENT surgery, supported by moderate-certainty evidence.
- Propofol may also reduce EA severity, though evidence certainty is very low.
- A slight increase in extubation time was observed, without significant impact on overall recovery or PACU stay.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:20Inhalational Anesthetics: Overview
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...