Purpose

Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA). However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed to evaluate the effect of subanesthetic propofol infusion on EA in children.

Methods

We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration.

Results

Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [n = 19]) than in the sevoflurane group (33.3% [n = 44]) (P = 0.005). After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25–0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24–0.93) than in the sevoflurane group.

Conclusion

Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.

中文翻译：

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亚麻醉剂量异丙酚输注预防儿童苏醒期躁动：一项回顾性观察研究

目的

使用丙泊酚维持麻醉和在手术结束时静脉注射丙泊酚已被证明可以预防苏醒期躁动 (EA)。然而，七氟醚麻醉期间亚麻醉输注丙泊酚对 EA 的预防作用仍不清楚。我们的目的是评估亚麻醉输注异丙酚对儿童 EA 的影响。

方法

我们回顾性比较了接受腺样体切除术、扁桃体切除术（伴或不伴腺样体切除术）或斜视手术的儿童中，单独使用七氟烷维持（七氟烷组）和亚麻醉异丙酚联合七氟烷维持（联合组）之间发生需要药物干预的严重 EA 的发生率。使用针对混杂因素进行调整的多变量逻辑回归模型来评估麻醉方法与 EA 发生之间的关联。此外，我们通过中介分析估计了麻醉方法的直接影响，排除了术中芬太尼和氟哌利多给药的间接影响。

结果

在 244 名符合条件的患者中，七氟醚组和联合组分别有 132 名和 112 名患者。联合组 (17.0% [ n  = 19]) 的 EA 粗发生率显着低于七氟醚组 (33.3% [ n  = 44]) ( P  = 0.005)。调整混杂因素后，联合组中 EA 的发生率仍然显着较低（调整后优势比 [aOR]：0.48，95% 置信区间 [CI] 0.25-0.91）。中介分析显示，与七氟醚组相比，麻醉方法与联合组中 EA 发生率较低（aOR：0.48，95% CI 0.24–0.93）有直接关联。

结论

亚麻醉输注异丙酚可有效预防需要阿片类药物或镇静剂的严重 EA。