DataSheet1_Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis.docx

BackgroundEmergence agitation (EA) is a common postoperative behavioral disorder, predominantly in pediatric patients, after sevoflurane general anesthesia. This study was aimed at assessing propofol's efficacy and clinical conditions established for preventing EA in children under sevoflurane anesthesia.
MethodsRandomized controlled trials (RCTs) that comparatively investigated propofol and control treatment in terms of efficacy and safety on administration at the end of surgery and examinations to prevent EA in children under sevoflurane anesthesia were searched. The sources accessed included PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Furthermore, manual searches were performed to identify studies; the last review was conducted on March 21, 2022. When the risk of bias assessment of trials was performed with the Cochrane Risk of Bias Tool, we calculated risk ratios (RRs) with 95% confidence intervals (CIs) for EA incidence and mean differences (MDs) with 95% CI for continuous data.
ResultsWe included 12 RCTs with 1103 children. EA incidence (RR: 0.51, 95% CI: 0.39 to 0.67) and Pediatric Anesthesia Emergence Delirium scores (MD: −3.14, 95% CI: −4.37 to −1.92) were lower in the propofol group. Subgroup analyses showed lower EA incidences with 3 mg/kg propofol (RR: 0.22, 95% CI: 0.13 to 0.38) without extension of the PACU time (MD: 4.97, 95% CI: −0.84 to 10.78) in the laryngeal mask airway (LMA; RR: 0.52, 95% CI: 0.36 to 0.77) and spontaneous breathing (RR: 0.36, 95% CI: 0.21 to 0.62) groups.
DiscussionWe confirmed that a prophylactic dose of propofol prevented EA and decreased its severity in children under sevoflurane anesthesia. Furthermore, several conditions such as 3 mg/kg propofol, LMA, and spontaneous breathing, potentially contributed to EA prevention.

Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274692, identifier: PROSPERO (No. CRD42021274692).

背景：苏醒期躁动（Emergence Agitation, EA）是七氟烷全身麻醉后常见的术后行为障碍，尤其多见于儿科患者。本研究旨在评估丙泊酚用于预防七氟烷麻醉下儿童EA的疗效及适宜临床给药方案。
方法：本研究检索了对比手术结束时给予丙泊酚与对照治疗，用于评估预防七氟烷麻醉下儿童EA的疗效与安全性的随机对照试验（Randomized Controlled Trial, RCTs）。检索数据库包括PubMed、Embase、《Cochrane对照试验中心注册库》及ClinicalTrials.gov，同时辅以手工检索，末次检索时间为2022年3月21日。采用Cochrane偏倚风险工具对纳入试验进行偏倚风险评估后，我们计算了EA发生率的风险比（Risk Ratio, RR）及95%置信区间（Confidence Interval, CI），以及连续变量的均数差（Mean Difference, MD）及95%CI。
结果：本研究共纳入12项RCTs，涉及1103名儿童。丙泊酚组的EA发生率（RR：0.51，95%CI：0.39~0.67）及小儿麻醉苏醒期谵妄评分（MD：-3.14，95%CI：-4.37~-1.92）均显著低于对照组。亚组分析显示，在喉罩通气（Laryngeal Mask Airway, LMA）与自主呼吸亚组中，采用3mg/kg丙泊酚可降低EA发生率，且未延长术后麻醉恢复室（Post Anesthesia Care Unit, PACU）停留时间；其中LMA亚组RR为0.52（95%CI：0.36~0.77），自主呼吸亚组RR为0.36（95%CI：0.21~0.62），3mg/kg丙泊酚亚组EA发生率RR为0.22（95%CI：0.13~0.38），术后PACU停留时间均数差为4.97（95%CI：-0.84~10.78）。
讨论：本研究证实，预防性给予丙泊酚可预防七氟烷麻醉下儿童发生EA，并降低其症状严重程度。此外，3mg/kg丙泊酚剂量、喉罩通气及自主呼吸等方案或可有效助力EA的预防。
系统评价注册信息：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274692，注册号：PROSPERO（编号CRD42021274692）。