The efficacy of propofol on emergence agitation--a meta-analysis of randomized controlled trials.

Abstract

Emergence agitation (EA) is a common, post-anesthetic complication in pediatric patients following sevoflurane and desflurane anesthesia. The aim of this meta-analysis was to assess the effects of an adjunctive dose of propofol to reduce the incidence of EA in pediatric patients. A comprehensive literature review was conducted to identify clinical trials focusing on the effects of propofol on EA in children under sevoflurane and desflurane anesthesia. The MEDLINE, EMBASE, Wiley Online Library, Web of Science, China National Knowledge Internet databases, and other sources were searched. The data were combined to calculate the pooled relative ratio (RR) or mean difference (MD), and relevant 95% confidence interval (CI). Heterogeneity and potential publication bias were assessed. The required information size was calculated and a Lan-DeMets sequential monitoring boundary was constructed to improve the precision of our findings. Data from 11 studies showed that an adjunctive dose of propofol conveyed a preventive effect on EA, as compared with placebo (RR = 0.56; 95% CI = 0.43-0.74; P < 0.0001). There was no significant difference in the length of stay in the post-anesthesia care unit between groups (MD = 0.25 min; 95% CI = -2.81 to 2.31; P = 0.85). The required information size was 2297 patients and the Lan-DeMets sequential monitoring boundary was crossed. However, most of the included studies had a high risk of bias and non-ignorable inter-study and clinical heterogeneity. Future studies on the benefits of adjunct propofol in reducing the incidence of EA are required.