The Recovery Characteristics Of A Few General Anesthetics:A Systematic Review

Objective To evaluate the incidence rate of emergence agitation after general anesthesia with sevoflurane or propofol in pediatric patients, and evaluate the emergence time, the incidence rate of postoperative nausea or vomiting (PONV), and the cognitive function after xenon anesthesia vs. isoflurane or xenon vs. sevoflurane. Methods Randomized controlled trials (RCTs) comparing emergence agitation after general anesthesia with sevoflurane or propofol in children, and involving postoperative recovery characteristics after xenon or isoflurane anesthesia and xenon or sevoflurane anesthesia were retrieved from PubMed(1966to December2012), EMbase(1974to December2012), Web of Science(1945to December2012), The Cochrane Library(Issue12,2012), CBM(1978to December2012), CNKI(1979to December2012), Wanfang database(1998to December2012), and VIP database(1989to December2012). The correlated references were also searched for complement. All included RCTs were assessed according to the standard of Cochrane systematic review and Meta-analysis was performed with RevMan5.1.7. Results A total of9RCTS involving692children were included and6RCTs was used for Meta-analysis comparing Sevoflurane versus propofol anesthesia for emergence agitation in pediatric patients. The results of Meta-analysis showed that after anesthesia induction with sevoflurane, intravenous propofol maintenance was associated with lower incidence of emergence agitation compared with sevoflurane maintenance [RR=0.57,95%CI(0.39,0.84)]; whereas patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane[RR=0.16,95%CI(0.06,0.39)]. A total of6RCTS involving449patients were included for comparing the postoperative recovery characteristics after xenon, isoflurane or sevoflurane anesthesia, Meta-analysis showed that the eye-opening time[SMD=-1.07,95%CI(-1.31,-0.82))](SMD:standard mean difference)and the extubation time[SMD=-2.04,95%CI(-3.30,-0.78)] after xenon anesthesia were shorter than those of isoflurane; And there was no difference about the Aldrete score5min after anesthesia between xenon and isoflurane [SMD=3.34,95%CI(-0.49,6.76)]. In addition, the results also showed that the eye-opening time[SMD=-1.54,95%CI(-2.00,-1.07)], the extubation time [SMD=-3.72,95%CI(-4.90,-2.55)], time to regain orientation[SMD=-2.20,95%CI(-3.84,-0.56)] and time to counting backward [SMD=-1.07,95%CI(-1.31,-0.82)] were shorter after xenon anesthesia; and there was no difference about the incidence of PONV between xenon and sevoflurane anesthesia[RR=1.26,95%CI(0.67,-2.38)]. Conclusion Children exposed in sevoflurane anesthesia are more prone to have emergence agitation compared with that of propofol. And current evidence suggests that the emergence time was shorter after xenon anesthesia compared with isoflurane and sevoflurane; and there was no significant difference about the Aldrete score after5min and the incidence of PONV between xenon, isoflurane and sevoflurane anesthesia. The cognitive function was recovered earlier after xenon anesthesia than that of sevoflurane.