Kuratani Norifumi, Oi Yumiko
Department of Anesthesiology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
Anesthesiology. 2008 Aug;109(2):225-32. doi: 10.1097/ALN.0b013e31817f5c18.
Sevoflurane is a popular inhalational anesthetic for general anesthesia in children. The higher incidence of emergence agitation has been suspected after sevoflurane anesthesia as compared with halothane, whereas some controlled studies showed conflicting results. In this report, the authors performed a meta-analysis of randomized controlled trials to compare the incidence of emergence agitation in children after sevoflurane or halothane anesthesia.
A comprehensive literature search was conducted to identify clinical trials that compared the incidence of emergence agitation in children anesthetized with sevoflurane versus halothane. Two reviewers independently assessed each report to meet the authors inclusion criteria and extracted data. The data from each trial were combined using the Mantel-Haenszel fixed-effect model to calculate the pooled odds ratio and 95% confidence interval. Funnel plots were used to assess publication bias. Subgroup analysis was used to clarify the effects of age, surgical procedure, pain treatment, and premedication on the incidence of emergence agitation.
The authors identified 23 studies that met their inclusion criteria. Overall, 1,252 patients received sevoflurane and 1,111 had halothane. Heterogeneity of data was statistically refuted. The pooled odds ratio for all studies was 2.21, with a 95% confidence interval of 1.77-2.77 (P < 0.0001). Publication bias was not apparent in a funnel plot. All subgroup analyses showed a higher incidence of agitation after sevoflurane anesthesia.
This meta-analysis revealed that emergence agitation occurred more frequently with sevoflurane than with halothane anesthesia in children.
七氟烷是儿童全身麻醉中常用的吸入性麻醉剂。与氟烷相比，七氟烷麻醉后出现苏醒期躁动的发生率较高，然而一些对照研究结果相互矛盾。在本报告中，作者对随机对照试验进行了荟萃分析，以比较七氟烷或氟烷麻醉后儿童苏醒期躁动的发生率。
进行全面的文献检索，以确定比较七氟烷与氟烷麻醉儿童苏醒期躁动发生率的临床试验。两名审阅者独立评估每份报告是否符合作者的纳入标准并提取数据。使用Mantel-Haenszel固定效应模型合并每个试验的数据，以计算合并比值比和95%置信区间。采用漏斗图评估发表偏倚。亚组分析用于阐明年龄、手术方式、疼痛治疗和术前用药对苏醒期躁动发生率的影响。
作者确定了23项符合其纳入标准的研究。总体而言，1252例患者接受七氟烷麻醉，1111例接受氟烷麻醉。数据的异质性在统计学上被否定。所有研究的合并比值比为2.21，95%置信区间为1.77-2.77（P<0.0001）。漏斗图中未显示明显的发表偏倚。所有亚组分析均显示七氟烷麻醉后躁动发生率较高。
这项荟萃分析表明，儿童七氟烷麻醉后苏醒期躁动的发生率高于氟烷麻醉。
