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Review
. 2022 Jun 22:9:924647.
doi: 10.3389/fsurg.2022.924647. eCollection 2022.

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

Ying Zhao  1 , Feng Qin  1   2 , Yuhang Liu  2 , Yanping Dai  1 , Xiaobo Cen  1
Affiliations
Review

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

Ying Zhao et al. Front Surg. .

Abstract

Background: Propofol 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.

Objectives: To evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.

Methods: Databases 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.

Results: Twenty 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).

Conclusions: This 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.

Keywords: children; general anesthesia; meta-analysis; propofol; sevoflurane.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study selection process for the meta-analysis with specifications of reasons.
Figure 2
Figure 2
Methodological quality assessment of trials using the Cochrane risk of bias tool. Symbols show low risk of bias (+), or unclear risk of bias (?)
Figure 3
Figure 3
Pooled estimate of the incidence of emergence agitation (EA) between sevoflurane and propofol for general anesthesia in children. Odds ratio >1.0 indicates that the incidence of EA is lower in the propofol group than that in sevoflurane group. The subheading “Events” refers to the number of EA. “Total” refers to the total number of individuals. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel method of calculation.
Figure 4
Figure 4
Pooled estimate of the incidence of postoperative nausea and vomiting (PONV) between sevoflurane and propofol groups for general anesthesia in children. Odds ratio >1.0 indicates that the incidence of PONV is lower in the propofol group than that in sevoflurane group. The subheading “Events” refers to the number of PONV. “Total” refers to the total number of individuals. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel method of calculation.
Figure 5
Figure 5
Pooled estimate of the incidence of postoperative pain (POP) between sevoflurane and propofol groups for general anesthesia in children. Odds ratio >1.0 indicates that the incidence of POP is lower in the propofol group than that in sevoflurane group. The subheading “Events” refers to the number of POP. “Total” refers to the total number of individuals. CI, confidence interval; df, degrees of freedom; M-H, Mantel-Haenszel method of calculation.
Figure 6
Figure 6
Pooled estimate of the extubation time (min) between sevoflurane and propofol groups for general anesthesia in children. Mean Difference < 0 indicates that the extubation time is shorter in the sevoflurane group than that in propofol group. The subheading “Total” refers to the total number of individuals. CI, confidence interval; df, degrees of freedom.
Figure 7
Figure 7
Pooled estimate of the time of postoperative eye-opening (min) between sevoflurane and propofol groups for general anesthesia in children. Mean Difference < 0 indicates that the time of postoperative eye-opening is shorter in the sevoflurane group than that in propofol group. The subheading “Total” refers to the total number of individuals. CI, confidence interval; df, degrees of freedom.
Figure 8
Figure 8
Funnel plots of randomized controlled trials.
See this image and copyright information in PMC

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