Zhao Ying, Qin Feng, Liu Yuhang, Dai Yanping, Cen Xiaobo
National Chengdu Center for Safety Evaluation of Drugs, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
Andrology Laboratory, Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Front Surg. 2022 Jun 22;9:924647. doi: 10.3389/fsurg.2022.924647. eCollection 2022.
Propofol and sevoflurane are the most used anesthetics for pediatric surgery. Emergence agitation, postoperative nausea and vomiting and postoperative pain are the primary adverse effect of these general anesthetics. Many clinical studies had compared the safety of propofol and sevoflurane in pediatric surgery, but the results were controversial.
To evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.
Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Vip Data were searched to collect relevant articles. Trials were strictly selected according to previously defined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses.
Twenty randomized controlled trials recruiting 1,550 children for general anesthesia were included, with overall low-moderate methodological quality. There was evidence that compared with sevoflurane anesthesia, propofol anesthesia significantly decreased the incidence of emergence agitation (OR = 4.99, 95% CI, 3.67-6.80; < 0.00001), postoperative nausea and vomiting (OR = 1.91, 95% CI, 1.27-2.87; = 0.002) and postoperative pain (OR = 1.72, 95% CI, 1.11-2.64; = 0.01) in children. However, patients who received sevoflurane tended to have shorter times to eye opening (MD = -2.58, 95% CI, -2.97- -2.19; < 0.00001) and times to extubation (MD = -1.42, 95% CI, -1.81- -1.02; < 0.00001).
This review reveals that the children who received propofol anesthesia had the lower risks of emergence agitation, postoperative nausea and vomiting and postoperative pain when compared with sevoflurane anesthesia. But the children who received sevoflurane recovered slightly faster than those received propofol. Considering the limitations of the included studies, better methodological quality and large controlled trials are expected to further quantify the safety of propofol and sevoflurane for general anesthesia in children.
丙泊酚和七氟醚是小儿外科手术中最常用的麻醉剂。苏醒期躁动、术后恶心呕吐和术后疼痛是这些全身麻醉剂的主要不良反应。许多临床研究比较了丙泊酚和七氟醚在小儿外科手术中的安全性，但结果存在争议。
评估丙泊酚与七氟醚用于小儿全身麻醉安全性的相关证据。
检索包括PubMed、Embase、Cochrane图书馆、中国知网、万方数据和维普数据在内的数据库，收集相关文章。根据预先定义的纳入和排除标准严格筛选试验。使用RevMan 5.3软件进行荟萃分析。
纳入20项随机对照试验，共1550例儿童接受全身麻醉，总体方法学质量为低到中等。有证据表明，与七氟醚麻醉相比，丙泊酚麻醉显著降低了儿童苏醒期躁动（OR = 4.99，95%CI，3.67 - 6.80；P < 0.00001）、术后恶心呕吐（OR = 1.91，95%CI，1.27 - 2.87；P = 0.002）和术后疼痛（OR = 1.72，95%CI，1.11 - 2.64；P = 0.01）的发生率。然而，接受七氟醚麻醉的患者睁眼时间（MD = -2.58，95%CI，-2.97 - -2.19；P < 0.00001）和拔管时间（MD = -1.42，95%CI，-1.81 - -1.02；P < 0.00001）往往更短。
本综述表明，与七氟醚麻醉相比，接受丙泊酚麻醉的儿童发生苏醒期躁动、术后恶心呕吐和术后疼痛的风险更低。但接受七氟醚麻醉的儿童恢复速度略快于接受丙泊酚麻醉的儿童。考虑到纳入研究的局限性，预计更好的方法学质量和大型对照试验将进一步量化丙泊酚和七氟醚用于小儿全身麻醉的安全性。
