The efficacy of propofol on emergence agitation – a meta‐analysis of randomized controlled trials

Jiang, Shasha; Liu, J.; Li, M.; Ji, Wentao; Liang, J.

doi:10.1111/aas.12586

Cited by 15 publications

(13 citation statements)

References 41 publications

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“…[ 5 ] Two meta-analyses have shown that administration of propofol in the dose range of 1–3 mg/kg was effective in reducing the incidence and severity of EA in children without affecting recovery time and time of care in the PACU. [ 2 3 ] Results from the present study indicate that a lower dose of 0.5 mg/kg of propofol exhibits a similar response in reducing the incidence of EA.…”

Section: Discussionsupporting

confidence: 54%

“…The incidence of EA varies around 10% to 80%, with the highest incidence found in patients aged 2 to 5 years. [ 2 3 ] A previous study by Aktara showed that the incidence of EA in our population was 39.7%. [ 4 ] Although it is a temporary and self-limiting condition, EA potentially endangers patients and threatens patient safety.…”

Section: Introductionmentioning

confidence: 79%

“…Incidence of EA varies greatly between 10% and 80%. [ 2 3 ] An earlier study in our institution observed the incidence of EA in children undergoing inhalational anesthesia as 39.7%. [ 4 ] We found the incidence of EA of 42 (38.9%) in the control group, which was similar to the previous study.…”

Section: Discussionmentioning

confidence: 98%

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Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane

Ramlan

Pardede

Marsaban

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm to the patient. This study evaluated the efficacy of 0.5 mg/kg of propofol administered at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia. Material and Methods: This double-blind randomized clinical trial was done in children aged 1–5 years undergoing general anesthesia with sevoflurane. One hundred and eight subjects were included using consecutive sampling method and randomized into two equal groups. Propofol in the dose of 0.5 mg/kg was administered at the end of anesthesia to children in the propofol group, while those in the control group did not receive any intervention at the end of anesthesia. Incidence of EA, transfer time, postoperative hypotension, desaturation, and nausea-vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium scale were used to assess EA. Results: Incidence of EA was 25.9% in the propofol group compared to 51.9% in the control group (RR = 0.500; 95% CI 0.298–0.840; P = 0.006). Mean transfer time in propofol group was longer (9.5 ± 3.9 min) than control group (7.8 ± 3.6 min) (mean difference 1.71 min; 95% CI 0.28–3.14; P = 0.020). Hypotension was found in one patient (1.9%) in propofol group, while in control group there was none. Nausea-vomiting was found in five patients (9.3%) in propofol group and eight patients (14.8%) in control. There was no desaturation in both the groups. Conclusion: Administration of 0.5 mg/kg of propofol at the end of anesthesia effectively reduces the incidence of EA in children undergoing general inhalational anesthesia with sevoflurane.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 79%

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Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane

Ramlan

Pardede

Marsaban

et al. 2020

J Anaesthesiol Clin Pharmacol

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“…has not been definitively shown to be effective in decreasing ED after a volatile anaesthetic. 23 42 64 Although a recent meta-analysis demonstrated that intraoperative propofol (1-3 mg kg À1 ) decreased EA in children, there were multiple confounders (midazolam, paracetamol, ketorolac, thiopental, morphine, fentanyl, sevoflurane, desflurane, and painful and non-painful procedures) 65 which, in this author's opinion, make the interpretation of the benefits of intraoperative propofol inadmissible.…”

Section: Gabapentinmentioning

confidence: 99%

Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Mason

2017

British Journal of Anaesthesia

171

190

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There remain unanswered questions and implications related to emergence delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still are unable to predict accurately those who are at greatest risk. Emergence delirium should be considered as a ‘vital sign’, which should be followed and documented in every child in the postanaesthesia recovery period. Standardized screening tools should be adopted for paediatric emergence delirium.

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“…Therefore, the therapy for agitation prevention and novel antiagitation drug development are quite limited because of the poor understands. At this moment, the common therapy for emergence agitation is sedative drugs, such as midazolam, propofol and opioids in clinical setting (13)(14)(15)(16). However, combined with other general anesthetics in PA-CU could significantly increase general anesthetic risk and result in respiratory depression and prolonged recovery.…”

mentioning

confidence: 99%

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker ZD7288 Prevents Sevoflurane-Induced Hyperactivity in A Novel Mice Behavioral Model

Peng¹,

Huang²,

Li³

et al. 2017

J Anesth Perioper Med

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Background: Besides effect of general anesthesia, sevoflurane also induces hyperactivity during induction and recovery, especially in young children. Lack of satisfied animal model impedes the investigation of causes of the hyperactivity as well as its prevention. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker might produce sedative effect. This study developed a novel mice model of hyperactive behaviors and further explored effects of HCN channel blocker on sevofluraneinduced hyperactivity. Methods: C57BL/6 mice were used in the present study. Maximal speed, mean speed, total movement distance and resting percentage of mice were quantitatively measured by behavioral tracking software. Age-dependence of this model was also analyzed. HCN channel blocker ZD7288 at doses of 6.25 and 12.5 μg/kg were intraperitoneal injected to prevent sevoflurane-induced hyperactivity. Results: In the behavioral model, sevoflurane could induce significant hyperactivity in mice under 1% sevoflurane inhalation and in recovery period, characterized as increased movement speed and total distance. The sevoflurane-induced hyperactivity was more significant in young mice than adult (P<0.01). Pre-administration of ZD7288 could significantly prevent sevoflurane-induced hyperactivity. Conclusions: The mice behavioral model developed in this study could characterize sevoflurane-induced hyperactivity in induction and recovery period as well as age-dependence. In addition, by this animal model, HCN channel blocker ZD7288 could prevent sevoflurane-induced hyperactivity. Thus, HCN channel might be the underlying therapeutic target for sevoflurane-induced agitation in general anesthesia.

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The efficacy of propofol on emergence agitation – a meta‐analysis of randomized controlled trials

Abstract: Future studies on the benefits of adjunct propofol in reducing the incidence of EA are required.

Cited by 15 publications

References 41 publications

Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane

Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane

Paediatric emergence delirium: a comprehensive review and interpretation of the literature

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker ZD7288 Prevents Sevoflurane-Induced Hyperactivity in A Novel Mice Behavioral Model

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