Kanaya Akihiro, Kuratani Norifumi, Satoh Daizoh, Kurosawa Shin
Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan,
J Anesth. 2014 Feb;28(1):4-11. doi: 10.1007/s00540-013-1656-y. Epub 2013 Jun 26.
Emergence agitation (EA) from general anesthesia has been reported as an adverse effect of sevoflurane in children. We describe a meta-analysis of randomized controlled trials that compared the incidence of EA between children who underwent sevoflurane anesthesia and those who underwent propofol anesthesia.
A literature search was conducted to identify clinical trials that met our inclusion criteria. Prospective randomized trials comparing sevoflurane and propofol anesthesia in children less than 15 years of age were included in the meta-analysis. Data from each trial were combined using the random effects model to calculate pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CIs). The heterogeneity of data was assessed by Cochran's Q and I (2) tests. Sensitivity analysis was conducted for study quality, patient age, and type of surgical procedure.
The meta-analysis included 14 studies, in which 560 patients received sevoflurane and 548 received propofol. The pooled OR for EA was 0.25 with a 95 % CI of 0.16-0.39 (P = 0.000), which indicates that propofol anesthesia resulted in a lower incidence of EA. The heterogeneity of data was not statistically supported (P = 0.191). All sensitivity analyses strengthened the evidence for the lower incidence of EA with propofol.
Our meta-analysis demonstrated that EA in children is less likely to occur after propofol anesthesia compared with sevoflurane anesthesia.
全身麻醉后出现的苏醒期躁动（EA）已被报道为七氟醚对儿童的一种不良反应。我们描述了一项随机对照试验的荟萃分析，该分析比较了接受七氟醚麻醉的儿童和接受丙泊酚麻醉的儿童中EA的发生率。
进行文献检索以确定符合我们纳入标准的临床试验。荟萃分析纳入了比较七氟醚和丙泊酚麻醉对15岁以下儿童影响的前瞻性随机试验。使用随机效应模型合并每个试验的数据，以计算合并比值比（OR）及其相应的95%置信区间（CI）。通过Cochran's Q和I²检验评估数据的异质性。对研究质量、患者年龄和手术类型进行敏感性分析。
荟萃分析纳入了14项研究，其中560例患者接受七氟醚麻醉，548例接受丙泊酚麻醉。EA的合并OR为0.25，95%CI为0.16 - 0.39（P = 0.000），这表明丙泊酚麻醉导致EA的发生率较低。数据的异质性没有统计学依据（P = 0.191）。所有敏感性分析都强化了丙泊酚导致EA发生率较低的证据。
我们的荟萃分析表明，与七氟醚麻醉相比，儿童在丙泊酚麻醉后发生EA的可能性较小。
