Prophylactic propofol reduces emergence agitation in children after general anesthesia.

pearl

• Sophia L van Hoff, Elizabeth S O'Neill, Lianna C Cohen, and Brian A Collins.
• Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
• Paediatr Anaesth. 2015 Jul 1; 25 (7): 668-76.

IntroductionEmergence agitation (EA) is common after sevoflurane anesthesia in children, and can lead to distressing inconsolability, agitation, crying, and injury. Use of a single dose of the short-acting sedative-hypnotic agent propofol at the end of a procedure has shown promise for preventing EA, but evidence evaluating the efficacy and safety of this approach has not been formally summarized.ObjectiveThe objective of this review was to assess the effects of a prophylactic dose of propofol vs placebo on the incidence and severity of EA in children age 0-13 years receiving general inhalational anesthesia.Search MethodsWe searched PubMed (1946-2013) via Medline, CENTRAL (1898-2013), and Web of Science (1900-2013) without limits or language restrictions; we also searched ClinicalTrials.gov and reference lists. We reviewed abstracts from the 2012 and 2013 Society for Pediatric Anesthesia meetings and pediatric anesthesia-related abstracts from the 2012 and 2013 International Anesthesia Research Society meetings.Selection CriteriaWe assessed randomized, double-blind trials evaluating the efficacy of a prophylactic dose of propofol (1 mg·kg(-1) ) vs placebo given at the end of inhalational anesthesia to prevent EA in pediatric patients. Studies were required to follow patients through recovery and report at least one prespecified outcome.Data Collection And AnalysisTwo authors independently assessed trial quality and extracted data from included studies. We contacted study authors regarding any missing data. We used the random effects models to calculate pooled relative risks (RR) and weighted mean differences (WMD). We collected Pediatric Anesthesia Emergence Delirium (PAED) scale scores from included studies. PAED scale scores can range from 0 to 20.Main ResultsOf 276 studies screened, nine trials involving 997 children met all inclusion criteria. All were considered low risk of bias. For one non-English trial, we obtained a full-text translation and for one non-English trial, we used the English-language abstract, tables, and figures. Based on available evidence, prophylactic propofol was associated with both decreased incidence of EA (29% vs 58%, RR 0.50, 95% confidence intervals [CI] 0.41, 0.61, I(2) = 37%, seven studies), and reduced severity of EA as assessed by mean PAED scale score (WMD -2.08 points, 95% CI -3.20, -0.96, I(2) = 0%, three studies), when compared to placebo. In addition, though prophylactic propofol did lengthen the time to awakening (WMD 4.07 min, 95% CI 2.22, 5.91, I(2) = 82%, six studies), it did not increase recovery time (WMD 2.91 min, 95% CI -0.59, 6.41, I(2) = 82%, six studies) when compared to placebo. No significant adverse events were reported in either arm.ConclusionBased on high quality evidence, prophylactic propofol appears to be effective for reducing the incidence and severity of EA in children emerging from general anesthesia.© 2015 John Wiley & Sons Ltd.

This article appears in the collections: Avoiding post-anesthesia emergence delirium in children and Propofol.

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