Sevoflurane Maintenance in Children: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Jiehao , HAN Ning ,  WU Xiuying

Corresponding author：

WU Xiuying, Email: wuxiuying0415@163.com

Keywords：

Sevoflurane; Pediatric anesthesia maintenance; Systematic review

DOI：

10.7507/1672-2531.20080218

Video：

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Objective 　We aimed to determine the efficacy and complication of sevoflurane maintenance in children.
Methods 　Trials were collected through electronic searches of MEDLINE, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, and CMBdisk (from the date of building the database to April 2008). We also checked the bibliographies of retrieved articles.
Results 　A total of 20 trials involving 1 592 patients were included. The Metaanalysis showed: ① Recovery time: sevoflurane was similar with propofol [WMD=0.22, 95%CI (–2.86, 3.30)], but slower than desflurane [WMD=5.01, 95%CI (2.87, 7.16)], and faster than isoflurane [WMD= –0.55, 95%CI (– 0.74, –0.37)]; ② Discharge time: sevoflurane was similar with propofol [WMD= –4.39, 95%CI (–10.02, 1.25)], desflurane[WMD=1.13, 95%CI (–3.25, 5.51)], and isoflurane [WMD= –8.17, 95%CI (–17.94, 1.60)]; ③ Postoperative agitation: sevoflurane was much more obvious than propofol [RR=5.53, 95%CI (2.99, 10.21)], but superior than desflurane [RR=0.55, 95%CI (0.35, 0.88)], and similar with isoflurane [RR=1.24, 95%CI (0.85, 1.800]; ④ Postoperative nausea and vomiting (PONV): sevoflurane was much more severe than propofol [RR=2.17, 95%CI (1.21, 3.90)], and no difference with desflurane [RR=0.88, 95%CI (0.61, 1.25)]; ⑤ Oculocardiac reflex: sevoflurane was less than propofol [RD= – 0.42, 95%CI (–0.56, –0.27)], and no difference with desflurane [RR=0.93, 95%CI (0.61, 1.41)].
Conclusion 　 The limited current evidence shows no difference between sevoflurane and propofol in recovery time, while the effect of sevoflurane is faster than isoflurane and slower than desflurane. There are no differences among sevoflurane, desflurane, isoflurane, and propofol in discharge time. The incidence of postoperative agitation of sevoflurane is higher than that of propofol, but lower than that of other inhaled anesthetics. The incidence of PONV of sevoflurane is higher than that of propofol. The incidence of oculocardiac reflex of sevoflurane is lower than that of propofol and similar with that of desflurane.

Citation： SUN Jiehao,HAN Ning,WU Xiuying. Sevoflurane Maintenance in Children: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(11): 988-996. doi: 10.7507/1672-2531.20080218 Copy

1.	Elliott RA, Payne K, Moore JK, et al. Clinical and economic choices in anaesthesia for day surgery: a prospective randomized controlled trial. Anaesthesia, 2003, 58(5): 412-421.
2.	邓晓明, 唐耿志, 罗茂萍, 等. 小儿七氟醚和异氟醚快速吸入诱导的比较. 现代外科, 1999, 5(2): 8-10.
3.	Sale SM, Read JA, Stoddart PA, et al. Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. Br J Anaesth, 2006, (6): 774-778.
4.	Picard V, Dumont L, Pellegrint M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44: 307-310.
5.	Ira TC, Juliac F, Raafat S, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13: 63-67.
6.	Lopéz GM, 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.
7.	Shin N, Hajime F, Hiromune Y. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in schoolaged children: a comparison with sevofl urane. J Anesth, 2007, 21: 19-23.
8.	杜怀清, 张鸿, 李萍, 等. 七氟烷、笑气复合七氟烷以及静脉丙泊酚用于小儿斜视手术麻醉的特点比较. 中国斜视与小儿眼科杂志, 2007, 15: 13-17.
9.	Jacob S, Rolf H, Martin K, et al. Hemodynamic differences between propofol–remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Pediatr Anesth, 2007, 17: 32-37.
10.	Yavuz G, Levent K, Kamil T. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9: 495-499.
11.	Simurina T, Mikulandra S, Mraović B, et al. The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy. Coll Antropol, 2006, 30(2): 343-247.
12.	Mayer J, Boldt J, Kerstin D, et al. Reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Pedtatr Anesth, 2006, 102: 400-404.
13.	Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
14.	曹建平, 徐葭, 缪小勇, 等. 低流量地氟醚和七氟醚在小儿麻醉的临床应用. 东南国防医药, 2007, 9: 188-189.
15.	Valley RD, Freid EB, Bailey AG, et al. Tracheal extubation of deeply anesthetized pediatric patients: A comparison of desflurane and sevoflurane. Anesth Analg, 2003, 96: 1320-1324.
16.	Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83: 917-920.
17.	Cohen IT, Juliac F, Raafat S, et al. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg, 2002, 94: 1178-1181.
18.	Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21: 538-542.
19.	Isik Y, Goksu S, Kocoglu H, et al. Low flow desflurane and sevoflurane anaesthesia in children. Eur J Anaesthesiol, 2006, 23: 60-64.
20.	Oh AY, Yun MJ, Kim HJ, et al. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth, 2007, 99(2): 262-265.
21.	Meyer RR, Peter M, Christian W, et al. Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children–a randomized controlled study. Pediatr Anesth, 2007, 17: 56-60.
22.	Bortone L, Ingelmo P, Grossi S, et al. Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia. Pediatr Anesth, 2006, 16: 1138-1143.
23.	Delvi MB, Samarkandi A, Zahrani T, et al. Recovery profile for magnetic resonance imaging in pediatric daycase--sevoflurane vs. isoflurane. Middle East J Anesthesiol, 2007, 19(1): 205-211.
24.	Fisher. Surrogate end points. Anaesthesiology, 1994, 81: 795-796.
25.	Brett CM, Zwass MS, France NK. Eyes, ears, nose, throat, and dental surgery. Gregory GA, Pediatric Anesthesia, 3rd edn, New York, Churchill Livingstone, 1994: 657-698.

1. Elliott RA, Payne K, Moore JK, et al. Clinical and economic choices in anaesthesia for day surgery: a prospective randomized controlled trial. Anaesthesia, 2003, 58(5): 412-421.
2. 邓晓明, 唐耿志, 罗茂萍, 等. 小儿七氟醚和异氟醚快速吸入诱导的比较. 现代外科, 1999, 5(2): 8-10.
3. Sale SM, Read JA, Stoddart PA, et al. Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. Br J Anaesth, 2006, (6): 774-778.
4. Picard V, Dumont L, Pellegrint M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand, 2000, 44: 307-310.
5. Ira TC, Juliac F, Raafat S, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13: 63-67.
6. Lopéz GM, 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.
7. Shin N, Hajime F, Hiromune Y. Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in schoolaged children: a comparison with sevofl urane. J Anesth, 2007, 21: 19-23.
8. 杜怀清, 张鸿, 李萍, 等. 七氟烷、笑气复合七氟烷以及静脉丙泊酚用于小儿斜视手术麻醉的特点比较. 中国斜视与小儿眼科杂志, 2007, 15: 13-17.
9. Jacob S, Rolf H, Martin K, et al. Hemodynamic differences between propofol–remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Pediatr Anesth, 2007, 17: 32-37.
10. Yavuz G, Levent K, Kamil T. Propofol-nitrous oxide versus sevoflurane-nitrous oxide for strabismus surgery in children. Paediatr Anaesth, 1999, 9: 495-499.
11. Simurina T, Mikulandra S, Mraović B, et al. The effect of propofol and fentanyl as compared with sevoflurane on postoperative vomiting in children after adenotonsillectomy. Coll Antropol, 2006, 30(2): 343-247.
12. Mayer J, Boldt J, Kerstin D, et al. Reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Pedtatr Anesth, 2006, 102: 400-404.
13. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevoflurane versus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
14. 曹建平, 徐葭, 缪小勇, 等. 低流量地氟醚和七氟醚在小儿麻醉的临床应用. 东南国防医药, 2007, 9: 188-189.
15. Valley RD, Freid EB, Bailey AG, et al. Tracheal extubation of deeply anesthetized pediatric patients: A comparison of desflurane and sevoflurane. Anesth Analg, 2003, 96: 1320-1324.
16. Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83: 917-920.
17. Cohen IT, Juliac F, Raafat S, et al. The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children. Anesth Analg, 2002, 94: 1178-1181.
18. Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21: 538-542.
19. Isik Y, Goksu S, Kocoglu H, et al. Low flow desflurane and sevoflurane anaesthesia in children. Eur J Anaesthesiol, 2006, 23: 60-64.
20. Oh AY, Yun MJ, Kim HJ, et al. Comparison of desflurane with sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery. Br J Anaesth, 2007, 99(2): 262-265.
21. Meyer RR, Peter M, Christian W, et al. Isoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children–a randomized controlled study. Pediatr Anesth, 2007, 17: 56-60.
22. Bortone L, Ingelmo P, Grossi S, et al. Emergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia. Pediatr Anesth, 2006, 16: 1138-1143.
23. Delvi MB, Samarkandi A, Zahrani T, et al. Recovery profile for magnetic resonance imaging in pediatric daycase--sevoflurane vs. isoflurane. Middle East J Anesthesiol, 2007, 19(1): 205-211.
24. Fisher. Surrogate end points. Anaesthesiology, 1994, 81: 795-796.
25. Brett CM, Zwass MS, France NK. Eyes, ears, nose, throat, and dental surgery. Gregory GA, Pediatric Anesthesia, 3rd edn, New York, Churchill Livingstone, 1994: 657-698.

Chinese Journal of Evidence-Based Medicine

Sevoflurane Maintenance in Children: A Systematic Review

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