Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomized controlled trials

Background: Sevoflurane is a popular inhalational anesthetic for general anesthesia in children. The higher incidence of emergence agitation has been suspected after sevoflurane anesthesia as compared with halothane, whereas some controlled studies showed conflicting results. In this report, the authors performed a meta-analysis of randomized controlled trials to compare the incidence of emergence agitation in children after sevoflurane or halothane anesthesia. Methods: A comprehensive literature search was conducted to identify clinical trials that compared the incidence of emergence agitation in children anesthetized with sevoflurane versus halothane. Two reviewers independently assessed each report to meet the authors inclusion criteria and extracted data. The data from each trial were combined using the Mantel-Haenszel fixed-effect model to calculate the pooled odds ratio and 95% confidence interval. Funnel plots were used to assess publication bias. Subgroup analysis was used to clarify the effects of age, surgical procedure, pain treatment, and premedication on the incidence of emergence agitation. Results: The authors identified 23 studies that met their inclusion criteria. Overall, 1,252 patients received sevoflurane and 1,111 had halothane. Heterogeneity of data was statistically refuted. The pooled odds ratio for all studies was 2.21, with a 95% confidence interval of 1.77-2.77 (P < 0.0001). Publication bias was not apparent in a funnel plot. All subgroup analyses showed a higher incidence of agitation after sevoflurane anesthesia. Conclusions: This meta-analysis revealed that emergence agitation occurred more frequently with sevoflurane than with halothane anesthesia in children.