Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies.
BACKGROUND
Emergence agitation (EA) in children is increased after sevoflurane anaesthesia. The efficacy of prophylactic treatment is controversial. The aim of this study was to provide a meta-analysis of the studies of the pharmacological prevention of EA in children.


METHODS
A comprehensive literature search was conducted to identify clinical trials that focused on the prevention of EA in children anaesthetized with sevoflurane, desflurane, or both. The data from each trial were combined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR) and 95% confidence interval. I(2) statistics were used to assess statistics heterogeneity and the funnel plot and the Begg-Mazumdar test to assess bias.


RESULTS
Thirty-seven articles were found which included a total of 1695 patients in the intervention groups and 1477 in the control ones. Midazolam and 5HT(3) inhibitors were not found to have a protective effect against EA [OR=0.88 (0.44, 1.76); OR=0.39 (0.12, 1.31), respectively], whereas propofol [OR=0.21 (0.16, 0.28)], ketamine [OR=0.28 (0.13, 0.60)], alpha(2)-adrenoceptors [OR=0.23 (0.17, 0.33)], fentanyl [OR=0.31 (0.18, 0.56)], and peroperative analgesia [OR=0.15 (0.07, 0.34)] were all found to have a preventive effect. Subgroup analysis according to the peroperative analgesia given does not affect the results.


CONCLUSIONS
This meta-analysis found that propofol, ketamine, fentanyl, and preoperative analgesia had a prophylactic effect in preventing EA. The analgesic properties of these drugs do not seem to have a role in this effect.
Dahmani
S
S
Department of Anesthesiology, Robert Debre University Hospital, Assistance Publique des Hôpitaux de Paris, 48 Bd Serurier, 75019 Paris, France. souhayl.dahmani@rdb.aphp.fr
Stany
I
I
Brasher
C
C
Lejeune
C
C
Bruneau
B
B
Wood
C
C
Nivoche
Y
Y
Constant
I
I
Murat
I
I
D017109:Akathisia, Drug-Induced / Q000209:etiology / Q000517:prevention & control*; D000698:Analgesia; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D002648:Child; D000077335:Desflurane; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D007649:Ketamine / Q000627:therapeutic use; D008738:Methyl Ethers / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000627:therapeutic use; D018341:Receptors, Adrenergic, alpha-2 / Q000627:therapeutic use; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D018341:Receptors, Adrenergic, alpha-2; D000077149:Sevoflurane; D007649:Ketamine; D000077335:Desflurane; D007530:Isoflurane; D005283:Fentanyl; D015742:Propofol