Effects of remifentanil on induction and recovery profiles during sevoflurane anesthesia in children -a meta-analysis of randomized controlled trials-

Abstract

Background: Although sevoflurane is widely used in pediatric anesthesa, its single use may be insufficient to prevent noxious stimuli induced by tracheal intubation or cause emergence agitation during recovery. Therefore, this meta-analysis was performed to determine whether administration of remifentanil may improve induction and recovery profiles during sevoflurane anesthesia in children.

Methods: A comprehensive literature search was conducted to identify randomized controlled trials involving children < 18 years of age who received sevoflurane anesthesia combined with or without intravenous remifentanil. Two authors independently assessed study quality and extracted data from included studies. Random-effects models were applied to calculate pooled risk ratios (RRs) for dichotomous data and standardized mean differences (SMDs) for continuous data with the corresponding 95% confidence intervals (CIs). The primary outcomes were hemodynamic changes during tracheal intubation and the incidence of emergence agitation during recovery.

Results: Out of 1920 studies screened, 13 studies involving 1237 children were included in the analysis. The use of remifentanil reduced changes of blood pressure [SMD (95% CI) -1.33 (-1.89, -0.77), P < 0.001, I2 = 87%] and heart rate [SMD (95% CI) -1.21 (-1.81, -0.61), P < 0.001, I2 = 89%] during tracheal intubation. The incidence of emergence agitation decreased when remifentanil was co-administered with sevoflurane during intraoperative period [SMD (95% CI) -1.21 (-1.81, -0.61), P < 0.001, I2 = 89%] as compared with the use of placebo.

Conclusion: This meta-analysis showed that the use of remifentanil attenuated hemodynamic fluctuation during tracheal intubation and decreased emergence agitation under sevoflurane anesthesia in children. ------------------------------------- Keywords: Pediatrics, Anesthesia, Intubation, Blood Pressure, Heart Rate, Postoperative Complications.