Li Caiping, Zhu Yongmei
Department of Anesthesiology, Xiantao Traditional Chinese Medicine Hospital, Xiantao, Hubei, China.
Outpatient Department, Xiantao Traditional Chinese Medicine Hospital, Xiantao, Hubei, China.
J Perianesth Nurs. 2025 Feb;40(1):158-168. doi: 10.1016/j.jopan.2024.03.006. Epub 2024 Sep 10.
Perioperative respiratory adverse events continue to pose significant challenges in pediatric anesthesia. Research has hinted at a lower incidence of these complications in children anesthetized with propofol than sevoflurane. This study aimed to assess and compare respiratory complications in children undergoing general anesthesia with either sevoflurane or propofol during surgery.
Systematic review and meta-analysis.
We conducted comprehensive searches of the PubMed, Embase, and Cochrane Library databases and manual searches to identify pertinent randomized controlled trials (RCTs) published up to August 19, 2023. The Cochrane risk assessment tool was employed to evaluate the risk of bias in the selected studies. The pooled analysis of relevant data compared respiratory complications, vomiting, agitation, anesthesia duration, extubation time, and recovery time in pediatric patients undergoing anesthesia with sevoflurane and propofol.
A total of 17 RCTs, containing 1,758 pediatric participants, were included and analyzed. Respiratory adverse events were examined, encompassing laryngospasm, apnea, cough, and SpO2. In comparison to sevoflurane, children subjected to propofol anesthesia demonstrated a significant reduction in the risk of laryngospasm (P = .001), vomiting (P < .001), and agitation (P = .029). Especially in patients receiving laryngeal mask airway, propofol anesthesia significantly reduced the incidence of laryngospasm (P = .003) and agitation (P < .001). At the same time, they exhibited an increased risk of apnea (P = .039). Notably, no statistically significant disparities were observed between sevoflurane and propofol concerning cough, SpO2 < 95%, anesthesia time, extubation time, and recovery time. Administration of propofol following sevoflurane anesthesia did not significantly impact the occurrence of vomiting or the recovery time.
While propofol presents an elevated risk of apnea, it concurrently yields a significant reduction in laryngospasm, vomiting, and agitation. Consequently, propofol emerges as a favorable anesthetic option for pediatric patients.
围手术期呼吸不良事件在小儿麻醉中仍然构成重大挑战。研究表明，与七氟醚相比，使用丙泊酚麻醉的儿童发生这些并发症的几率较低。本研究旨在评估和比较在手术期间接受七氟醚或丙泊酚全身麻醉的儿童的呼吸并发症。
系统评价和荟萃分析。
我们对PubMed、Embase和Cochrane图书馆数据库进行了全面检索，并进行了手工检索，以识别截至2023年8月19日发表的相关随机对照试验（RCT）。采用Cochrane风险评估工具评估所选研究的偏倚风险。对相关数据进行汇总分析，比较了接受七氟醚和丙泊酚麻醉的小儿患者的呼吸并发症、呕吐、躁动、麻醉持续时间、拔管时间和恢复时间。
共纳入并分析了17项RCT，涉及1758名儿科参与者。对包括喉痉挛、呼吸暂停、咳嗽和SpO2在内的呼吸不良事件进行了检查。与七氟醚相比，接受丙泊酚麻醉的儿童发生喉痉挛（P = 0.001）、呕吐（P < 0.001）和躁动（P = 0.029）的风险显著降低。特别是在接受喉罩气道通气的患者中，丙泊酚麻醉显著降低了喉痉挛（P = 0.003）和躁动（P < 0.001）的发生率。同时，他们发生呼吸暂停的风险增加（P = 0.039）。值得注意的是，在咳嗽、SpO2 < 95%、麻醉时间、拔管时间和恢复时间方面，七氟醚和丙泊酚之间未观察到统计学上的显著差异。在七氟醚麻醉后给予丙泊酚对呕吐的发生或恢复时间没有显著影响。
虽然丙泊酚导致呼吸暂停的风险增加，但它同时显著降低了喉痉挛、呕吐和躁动的发生率。因此，丙泊酚成为小儿患者良好的麻醉选择。
