七氟醚和丙泊酚全身麻醉对小儿术后躁动影响的系统评价_《中国循证医学杂志》

作者：

张海军 ,  李玉兰 , 孙绕 , 刘景景

兰州大学第一临床医学院麻醉科（兰州　730000）;

关键词：

七氟醚丙泊酚全身麻醉儿童躁动谵妄系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130234

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价七氟醚和丙泊酚全身麻醉对小儿术后躁动发生率的影响。
方法　计算机检索PubMed、SCI、EMbase、The Cochrane Library（2012年第4期）、CNKI、CBM、WanFang Data和VIP等数据库，全面收集七氟醚和丙泊酚麻醉对小儿术后躁动影响的随机对照试验（RCT），检索时限均为建库至2012年12月，并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan 5.1软件进行Meta分析。
结果　共纳入9个RCT，但仅6个可进行定量分析，共692例患儿。Meta分析结果显示：① 经七氟醚诱导后，丙泊酚维持组的躁动发生率低于七氟醚维持组［RR=0.57，95%CI（0.39，0.84），P=0.004］；② 全程丙泊酚静脉麻醉组的躁动发生率低于全程七氟醚吸入麻醉组［RR=0.16，95%CI（0.06，0.39），P lt;0.000 1］。
结论　七氟醚麻醉小儿术后躁动发生率高于丙泊酚麻醉。受纳入研究数量与质量限制，临床上在选择是否使用七氟醚麻醉之前，应该对患儿各方面情况进行综合考虑。

引用本文： 张海军,李玉兰,孙绕,刘景景. 七氟醚和丙泊酚全身麻醉对小儿术后躁动影响的系统评价. 中国循证医学杂志, 2013, 13(11): 1367-1372. doi: 10.7507/1672-2531.20130234 复制

1.	Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth, 2010, 104(2): 216-23.
2.	Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction: A meta-analysis. Anesthesia and Analgesia, 2000, 91(1): 213-219.
3.	Kuratani N. Emergence agitation in pediatric anesthesia. Masui, 2007, 56(5): 554-559.
4.	Konig MW, Varughese AM, Brennen KA, et al. Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial. Paediatr Anaesth, 2009,19(8): 748-755.
5.	Pieters BJ, Penn E, Nicklaus P, et al. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth, 2010, 20(10): 944-950.
6.	Bryan YF, Hoke LK, Taghon TA, et al. A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth, 2009, 19(7): 672-681.
7.	Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
8.	Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
9.	Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
10.	Nakayama S, Furukawa H, Yanai H. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane. J Anesth, 2007, 21(1): 19-23.
11.	Kol IO, Egilmez H, Kaygusuz K, et al. Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients. Clin Ther, 2008, 30(1): 175-181.
12.	Lopez Gil ML, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth, 1999, 9(6): 485-490.
13.	Bayindir O, Akpinar B, Can E, et al. The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth, 2000, 14(3): 288-292.
14.	Kim, JH. Mechanism of emergence agitation induced by sevoflurane anesthesia. Korean J Anesthesiol, 2011, 60(2): 73-74.
15.	Lankinen U, Avela R, Tarkkila P. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy. Anesth Analg, 2006, 102(5): 1383-1386.
16.	Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry, 2000, 61(Suppl 14): 5-10.
17.	Eom W, Lee JM, Park J, et al. The effects of midazolam and sevoflurane on the GABA(A) receptors with alternatively spliced variants of the gamma2 subunit. Korean J Anesthesiol, 2011, 60(2): 109-118.
18.	Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth, 2008, 18(1): 55-59.
19.	Aouad MT, Yazbeck-Karam VG, Nasr VG, et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology, 2007, 107(5): 733-738.
20.	Kim MS, Moon BE, Kim H, et al. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth, 2013, 110(2): 274-280.
21.	Kim YH, Yoon SZ, Lim HJ, et al. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care, 2011, 39(5): 904-908.
22.	Lee CJ, Lee SE, Oh MK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol, 2010, 59(2): 75-81.
23.	Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth, 2007, 17(9): 846-850.
24.	Malviya S, Voepel-Lewis T, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth, 2006, 16(5): 554-559.
25.	Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367.
26.	Breschan C, Platzer M, Jost R, et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Paediatr Anaesth, 2007, 17(4): 347-352.
27.	Bae JH, Koo BW, Kim SJ, et al. The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery. Korean J Anesthesiol, 2010, 58(1): 45-49.
28.	Kubo S, Kinouchi K, Taniguchi A, et al. Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia. Masui, 2001, 50(4): 371-377.

1. Dahmani S, Stany I, Brasher C, et al. Pharmacological prevention of sevoflurane- and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth, 2010, 104(2): 216-23.
2. Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction: A meta-analysis. Anesthesia and Analgesia, 2000, 91(1): 213-219.
3. Kuratani N. Emergence agitation in pediatric anesthesia. Masui, 2007, 56(5): 554-559.
4. Konig MW, Varughese AM, Brennen KA, et al. Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial. Paediatr Anaesth, 2009,19(8): 748-755.
5. Pieters BJ, Penn E, Nicklaus P, et al. Emergence delirium and postoperative pain in children undergoing adenotonsillectomy: a comparison of propofol vs sevoflurane anesthesia. Paediatr Anaesth, 2010, 20(10): 944-950.
6. Bryan YF, Hoke LK, Taghon TA, et al. A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans. Paediatr Anaesth, 2009, 19(7): 672-681.
7. Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
8. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
9. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
10. Nakayama S, Furukawa H, Yanai H. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane. J Anesth, 2007, 21(1): 19-23.
11. Kol IO, Egilmez H, Kaygusuz K, et al. Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients. Clin Ther, 2008, 30(1): 175-181.
12. Lopez Gil ML, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth, 1999, 9(6): 485-490.
13. Bayindir O, Akpinar B, Can E, et al. The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth, 2000, 14(3): 288-292.
14. Kim, JH. Mechanism of emergence agitation induced by sevoflurane anesthesia. Korean J Anesthesiol, 2011, 60(2): 73-74.
15. Lankinen U, Avela R, Tarkkila P. The prevention of emergence agitation with tropisetron or clonidine after sevoflurane anesthesia in small children undergoing adenoidectomy. Anesth Analg, 2006, 102(5): 1383-1386.
16. Lindenmayer JP. The pathophysiology of agitation. J Clin Psychiatry, 2000, 61(Suppl 14): 5-10.
17. Eom W, Lee JM, Park J, et al. The effects of midazolam and sevoflurane on the GABA(A) receptors with alternatively spliced variants of the gamma2 subunit. Korean J Anesthesiol, 2011, 60(2): 109-118.
18. Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth, 2008, 18(1): 55-59.
19. Aouad MT, Yazbeck-Karam VG, Nasr VG, et al. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology, 2007, 107(5): 733-738.
20. Kim MS, Moon BE, Kim H, et al. Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children. Br J Anaesth, 2013, 110(2): 274-280.
21. Kim YH, Yoon SZ, Lim HJ, et al. Prophylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia. Anaesth Intensive Care, 2011, 39(5): 904-908.
22. Lee CJ, Lee SE, Oh MK, et al. The effect of propofol on emergence agitation in children receiving sevoflurane for adenotonsillectomy. Korean J Anesthesiol, 2010, 59(2): 75-81.
23. Abu-Shahwan I, Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr Anaesth, 2007, 17(9): 846-850.
24. Malviya S, Voepel-Lewis T, Ramamurthi RJ, et al. Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile. Paediatr Anaesth, 2006, 16(5): 554-559.
25. Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367.
26. Breschan C, Platzer M, Jost R, et al. Midazolam does not reduce emergence delirium after sevoflurane anesthesia in children. Paediatr Anaesth, 2007, 17(4): 347-352.
27. Bae JH, Koo BW, Kim SJ, et al. The effects of midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery. Korean J Anesthesiol, 2010, 58(1): 45-49.
28. Kubo S, Kinouchi K, Taniguchi A, et al. Recovery characteristics of propofol anesthesia in pediatric outpatients; comparison with sevoflurane anesthesia. Masui, 2001, 50(4): 371-377.

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《中国循证医学杂志》

七氟醚和丙泊酚全身麻醉对小儿术后躁动影响的系统评价

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