七氟醚和丙泊酚全身麻醉對小兒術后躁動影響的系統評價_《中國循證醫學雜志》

作者：

張海軍 ,  李玉蘭 , 孫繞 , 劉景景

蘭州大學第一臨床醫學院麻醉科（蘭州　730000）;

關鍵詞：

七氟醚丙泊酚全身麻醉兒童躁動譫妄系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130234

視頻：

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目的　系統評價七氟醚和丙泊酚全身麻醉對小兒術后躁動發生率的影響。
方法　計算機檢索PubMed、SCI、EMbase、The Cochrane Library（2012年第4期）、CNKI、CBM、WanFang Data和VIP等數據庫，全面收集七氟醚和丙泊酚麻醉對小兒術后躁動影響的隨機對照試驗（RCT），檢索時限均為建庫至2012年12月，并追溯納入研究的參考文獻。由兩位研究者按照納入與排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　共納入9個RCT，但僅6個可進行定量分析，共692例患兒。Meta分析結果顯示：① 經七氟醚誘導后，丙泊酚維持組的躁動發生率低于七氟醚維持組［RR=0.57，95%CI（0.39，0.84），P=0.004］；② 全程丙泊酚靜脈麻醉組的躁動發生率低于全程七氟醚吸入麻醉組［RR=0.16，95%CI（0.06，0.39），P lt;0.000 1］。
結論　七氟醚麻醉小兒術后躁動發生率高于丙泊酚麻醉。受納入研究數量與質量限制，臨床上在選擇是否使用七氟醚麻醉之前，應該對患兒各方面情況進行綜合考慮。

引用本文： 張海軍,李玉蘭,孫繞,劉景景. 七氟醚和丙泊酚全身麻醉對小兒術后躁動影響的系統評價. 中國循證醫學雜志, 2013, 13(11): 1367-1372. doi: 10.7507/1672-2531.20130234 復制

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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七氟醚和丙泊酚全身麻醉對小兒術后躁動影響的系統評價

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《中國循證醫學雜志》

七氟醚和丙泊酚全身麻醉對小兒術后躁動影響的系統評價

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