Tan Yuan, Shi Yisa, Ding Hui, Kong Xiangbin, Zhou Haijiao, Tian Jinhui
Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China.
Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
Paediatr Anaesth. 2016 Feb;26(2):139-50. doi: 10.1111/pan.12815. Epub 2015 Nov 28.
Emergence agitation (EA) is an adverse effect after sevoflurane anesthesia in pediatric patients. The effectiveness of prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil in preventing EA is debatable.
A literature search was conducted to identify clinical trials that observed the effect of μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil on preventing EA in pediatric patients under sevoflurane anesthesia. The statistical software RevMan 5.3 was used for meta-analysis. Data from each study were combined using the relative ratio (RR), weighted mean differences, and their associated 95% confidence intervals. I(2) was used to evaluate heterogeneity. Subgroup analysis was conducted to investigate the possible influences of patient age, adenotonsillectomy, premedication, N2 O, propofol, and regional block/local anesthetics on preventing EA with prophylactic administration of μ-opioid agonists. Publication bias was checked using funnel plots and Begg's test.
This meta-analysis showed the inclusion of 19 randomized controlled trials with 1528 patients (857 patients received μ-opioid agonists therapy and 671 patients had placebo). The pooled data indicated that prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil significantly decreased the incidence of EA [RR = 0.49 (0.38, 0.64), I(2) = 42%, P = 0.04; RR = 0.57 (0.33, 0.99), I(2) = 37%, P = 0.19; RR = 0.18 (0.08, 0.39), I(2) = 0%, P = 0.98; and RR = 0.56 (0.40, 0.78), I(2) = 6%, P = 0.34, respectively]. All subgroup analyses strengthened the proof for lower incidence of EA under sevoflurane anesthesia after fentanyl administration. A possibility of publication bias was detected in the fentanyl group.
This meta-analysis suggested that prophylactic μ-opioid agonists fentanyl, remifentanil, sufentanil, and alfentanil could significantly decrease the incidence of EA under sevoflurane anesthesia in children compared to placebo. Considering the limitations of the included studies, more clinical studies are required.
小儿患者七氟醚麻醉后出现的苏醒期躁动（EA）是一种不良反应。预防性使用μ-阿片受体激动剂芬太尼、瑞芬太尼、舒芬太尼和阿芬太尼预防EA的有效性存在争议。
进行文献检索，以确定观察μ-阿片受体激动剂芬太尼、瑞芬太尼、舒芬太尼和阿芬太尼对七氟醚麻醉下小儿患者预防EA效果的临床试验。使用统计软件RevMan 5.3进行荟萃分析。各研究数据采用相对比（RR）、加权均数差及其相关的95%置信区间进行合并。I²用于评估异质性。进行亚组分析，以研究患者年龄、腺样体扁桃体切除术、术前用药、N₂O、丙泊酚以及区域阻滞/局部麻醉药对预防性使用μ-阿片受体激动剂预防EA的可能影响。使用漏斗图和Begg检验检查发表偏倚。
该荟萃分析纳入19项随机对照试验，共1528例患者（857例接受μ-阿片受体激动剂治疗，671例接受安慰剂）。汇总数据表明，预防性使用μ-阿片受体激动剂芬太尼、瑞芬太尼、舒芬太尼和阿芬太尼可显著降低EA的发生率[RR分别为0.49（0.38，0.64），I² = 42%，P = 0.04；RR = 0.57（0.33，0.99），I² = 37%，P = 0.19；RR = 0.18（0.08，0.39），I² = 0%，P = 0.98；RR = 0.56（0.40，0.78），I² = 6%，P = 0.34]。所有亚组分析均进一步证明芬太尼给药后七氟醚麻醉下EA发生率较低。在芬太尼组中检测到存在发表偏倚的可能性。
该荟萃分析表明，与安慰剂相比，预防性使用μ-阿片受体激动剂芬太尼、瑞芬太尼、舒芬太尼和阿芬太尼可显著降低小儿七氟醚麻醉下EA的发生率。考虑到纳入研究的局限性，需要更多的临床研究。
