Effects of intravenous fentanyl around the end of surgery on emergence agitation in children: Systematic review and meta-analysis

Abstract

Background: Emergence agitation is a serious postoperative problem in children undergoing general anesthesia. The use of fentanyl around the end of surgery has been proposed to prevent emergence agitation. However, the efficacy and disadvantages of this method remain uncertain because previous results have not been consistent, depending on the variable assessed.

Methods: In July 2016, the PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, and KoreaMed were searched for randomized controlled trials that compared fentanyl (1 μg/kg) and placebo administered around the end of surgery to prevent emergence agitation after general anesthesia in children between birth and 14 years of age. The collected outcomes included the incidence or score of emergence agitation, variables regarding anesthesia recovery, and adverse events (eg, postoperative nausea or vomiting).

Results: A total of 10 randomized controlled trials (718 patients, 357 receiving fentanyl) were included. Fentanyl around the end of surgery significantly decreased emergence agitation incidence (emergence agitation: relative risk 0.43, 95% confidence interval 0.35 to 0.53, I² =0.0%; severe emergence agitation: relative risk 0.50, 95% confidence interval 0.31 to 0.81, I² =0.0%). From subgroup analyses, fentanyl at the end of surgery was associated with a prolonged postanesthesia care unit stay and increased postoperative nausea or vomiting incidence (weighted mean difference 6.09, 95% confidence interval 2.77 to 9.41, I² =58.6%; relative risk 2.61, 95% confidence interval 1.58 to 4.33, I² =32.4%), whereas fentanyl at 10-20 minutes before the end of surgery did not increase postanesthesia care unit stay or postoperative nausea or vomiting risk (weighted mean difference -1.15, 95% confidence interval -5.15 to 2.85, I² =89.0%; relative risk 1.32, 95% confidence interval 0.66 to 2.66, I² =0.0%).

Conclusions: The current analyses indicate that fentanyl around the end of surgery reduces the incidence of emergence agitation in children undergoing general anesthesia.

Keywords: anesthesia; child; delirium; fentanyl; pediatrics; psychomotor agitation.