Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies

Jan 6, 2010British journal of anaesthesia

Drugs that may prevent agitation in children waking up from sevoflurane or desflurane anesthesia: a combined analysis of studies

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Abstract

A total of 1695 patients received interventions aimed at preventing emergence agitation after sevoflurane anaesthesia.

Midazolam and 5HT(3) inhibitors did not show protective effects against emergence agitation.
Propofol demonstrated a significant preventive effect with an odds ratio of 0.21.
Ketamine also showed a preventive effect with an odds ratio of 0.28.
Alpha(2)-adrenoceptors and fentanyl were found to have preventive effects with odds ratios of 0.23 and 0.31, respectively.
Peroperative analgesia was associated with a preventive effect, indicated by an odds ratio of 0.15.
The analgesic properties of these drugs appear to be unrelated to their effectiveness in preventing emergence agitation.

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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.

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Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies

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