Liao Ruting, Zhou Zhijian, Wang Xuan, Shao Huiying
Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China.
Br J Hosp Med (Lond). 2024 Nov 30;85(11):1-15. doi: 10.12968/hmed.2024.0431. Epub 2024 Nov 18.
Perioperative respiratory adverse events (PRAEs) are common in pediatric anesthesia, especially in otolaryngology procedures. In this randomized controlled trial, we investigated the impact of administering propofol before extubation on PRAEs in pediatric patients undergoing tonsillectomy and adenoidectomy. We enrolled children aged 3 to 8 years old, of American Society of Anesthesiologists (ASA) classes I to III, scheduled for tonsillectomy, and randomly divided them into propofol and control groups. The subjects in the propofol group received multiple small doses of propofol (0.5 mg/kg per dose, total 1-2 mg/kg) until the patient resumed regular spontaneous breathing and exhibited no bodily movements. The subjects in the control group received 0.15 mL/kg of saline. The primary outcome was the rate of PRAEs, such as laryngospasm, bronchospasm, breath-holding spell, severe coughing, desaturation, and airway obstruction, post-extubation. The secondary outcomes were the extubation time, pre-extubation Richmond Agitation-Sedation Scale (RASS) score, end-tidal sevoflurane concentration at extubation, incidence of postoperative agitation, time to consciousness, and Face, Legs, Activity, Cry, and Consolability (FLACC) pain score in the recovery room. Results were reported with risk ratios (RR) and their 95% confidence intervals (CI), as well as the -values indicating statistical significance. A total of 239 patients were included, including 119 in the propofol group and 120 in the control group. Our findings indicated no significant difference in the rate of PRAEs between the two groups (5.9% vs 10.8%, RR: 0.54, 95% CI: 0.23 to 1.31, = 0.17). However, the propofol group showed a notable decrease in moderate to severe coughs (13.4% vs 60.0%, RR: 0.22, 95% CI: 0.14 to 0.36, < 0.001) and postoperative agitation (4.2% vs 60.8%, RR: 0.07, 95% CI: 0.03 to 0.17, < 0.001). This trial demonstrated that while administering repeated small doses of propofol before extubation does not significantly reduce respiratory adverse events in children undergoing tonsillectomy and adenoidectomy, it does significantly reduce the incidence of severe coughing, improving postoperative recovery and clinical outcomes. Moreover, propofol helps reduce postoperative agitation, enhancing the safety and effectiveness of postoperative care, and maintaining its valuable clinical role in postoperative management. ClinicalTrials.gov (NCT05769842).
围手术期呼吸不良事件（PRAEs）在小儿麻醉中很常见，尤其是在耳鼻喉科手术中。在这项随机对照试验中，我们研究了在拔管前给予丙泊酚对接受扁桃体切除术和腺样体切除术的小儿患者PRAEs的影响。我们纳入了年龄在3至8岁、美国麻醉医师协会（ASA）分级为I至III级、计划进行扁桃体切除术的儿童，并将他们随机分为丙泊酚组和对照组。丙泊酚组的受试者接受多次小剂量丙泊酚（每剂0.5mg/kg，总量1-2mg/kg），直到患者恢复规律的自主呼吸且无身体动作。对照组的受试者接受0.15mL/kg的生理盐水。主要结局是拔管后PRAEs的发生率，如喉痉挛、支气管痉挛、屏气发作、严重咳嗽、血氧饱和度下降和气道梗阻。次要结局包括拔管时间、拔管前里士满躁动镇静量表（RASS）评分、拔管时呼气末七氟醚浓度、术后躁动发生率、意识恢复时间以及恢复室中的面部、腿部、活动、哭闹和安慰度（FLACC）疼痛评分。结果以风险比（RR）及其95%置信区间（CI）以及表示统计学显著性的P值报告。总共纳入了239例患者，其中丙泊酚组119例，对照组120例。我们的研究结果表明，两组之间PRAEs的发生率没有显著差异（5.9%对10.8%，RR：0.54，95%CI：0.23至1.31，P = 0.17）。然而，丙泊酚组中重度咳嗽（13.4%对60.0%，RR：0.22，95%CI：0.14至0.36，P < 0.001）和术后躁动（4.2%对60.8%，RR：0.07，95%CI：0.03至0.17，P < 0.001）显著减少。该试验表明，虽然在拔管前给予重复小剂量丙泊酚并不能显著降低接受扁桃体切除术和腺样体切除术儿童的呼吸不良事件，但它确实显著降低了严重咳嗽的发生率，改善了术后恢复和临床结局。此外，丙泊酚有助于减少术后躁动，提高术后护理的安全性和有效性，并在术后管理中保持其重要的临床作用。ClinicalTrials.gov（NCT05769842）。
