The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundPropofol 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.ObjectivesTo evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.MethodsDatabases 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.ResultsTwenty 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; P < 0.00001), postoperative nausea and vomiting (OR = 1.91, 95% CI, 1.27–2.87; P = 0.002) and postoperative pain (OR = 1.72, 95% CI, 1.11–2.64; P = 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; P < 0.00001) and times to extubation (MD = −1.42, 95% CI, −1.81– −1.02; P < 0.00001).ConclusionsThis 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.

Comparison of the Agitation-Reducing Effects of Esmolol and Lidocaine in Pediatric Strabismus Surgery: A Double-Blind, Randomized Clinical Study

“…it increases the severity of agitation and the risk of PONV. Despite these disadvantages, sevoflurane is widely used as an inhalational anesthetic worldwide because it reduces airway irritation and has a faster awakening time in pediatric patients [23]. Therefore, this study used sevoflurane to maintain anesthesia.…”

“…In particular, the use of small doses of propofol for prophylactic purposes after surgery can cause delayed awakening and complications such as hypoxia due to apnea [30]. Thus, the use of propofol to reduce agitation is associated with some limitations [23]. Dexmedetomidine has also been reported to reduce agitation in pediatric patients [26].…”

Comparison of Sevoflurane Inhalation Anesthesia and Total Intravenous Anesthesia with Propofol in Terms of Postoperative Sore Throat and Nausea/Vomiting in Septorhinoplasty Cases

“…(2). In today's general anesthesia applications, both total intravenous anesthesia (TIVA) with propofol and inhalation anesthesia with sevoflurane are frequently used because of their pharmacological properties (3)(4)(5).…”

“…Propofol is an intravenous anesthetic with a short duration of action, which is widely used for the induction and maintenance of anesthesia. It has advantages such as rapid effect, rapid recovery, stability, and preventing nausea and vomiting (3,15). It has been reported that propofol has a lower incidence of PONV compared to inhaled anesthetics (15).…”

“…Sevoflurane is a volatile anesthetic agent with the advantages of rapid induction, easy control of depth of anesthesia, rapid recovery, and limited respiratory depression (3,15,16). Sevoflurane is one of the most commonly used inhalation anesthetics in general anesthesia applications (1,15,19).…”