Evaluation of Propofol in Comparison with Other General Anesthetics for Surgery in Children Younger than 3 Years: a Systematic Review and Meta-Analysis

Abstract

Background: Despite well-known advantages, propofol remains off-label in many countries for general anesthesia in children under 3 years of age due to insufficient evidence regarding its use in this population. This study aimed to evaluate the efficacy and safety of propofol compared with other general anesthetics in children under 3 years of age undergoing surgery through a systematic review and meta-analysis of existing randomized clinical trials.

Methods: A comprehensive literature search was conducted of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to find all randomized clinical trials comparing propofol with another general anesthetic that included children under 3 years of age. The relative risk or arcsine-transformed risk difference for dichotomous outcomes and the weighted or standardized mean difference for continuous outcomes were estimated using a random-effects model.

Results: A total of 249 young children from 6 publications were included. The children who received propofol had statistically significantly lower systolic and diastolic blood pressures, but hypotension was not observed in the propofol groups. The heart rate, stroke volume index, and cardiac index were not significantly different between the propofol and control groups. The propofol groups showed slightly shorter recovery times and a lower incidence of emergence agitation than the control groups, while no difference was observed for the incidence of hypotension, desaturation, and apnea.

Conclusion: This systematic review and meta-analysis indicates that propofol use for general anesthesia in young healthy children undergoing surgery does not increase complications and that propofol could be at least comparable to other anesthetic agents.

Keywords: Child; General Anesthesia; Infant; Propofol; Systematic Review.

Fig. 1. Flow diagram of the literature search.

RCT = randomized clinical trial, LCT = long-chain triglyceride, MCT = medium-chain triglyceride.

Fig. 2. Forest plots of hemodynamic responses. (A) Minimum systolic blood pressure. (B) Minimum diastolic blood pressure. (C) Minimum heart rate. (D) Minimum stroke volume index. (E) Minimum cardiac output. (F) Minimum cardiac index.

SD = standard deviation, WMD = weighted mean difference, CI = confidence interval, MD = mean difference, SMD = standardized mean difference.

Fig. 3. Forest plots of recovery times. (A) Time to extubation (min). (B) Time to emergence/eye opening (min).

SD = standard deviation, WMD = weighted mean difference, CI = confidence interval.

Fig. 4. Forest plots of adverse events. (A) Hypotension. (B) Desaturation. (C) Apnea. (D) Postoperative vomiting. (E) Emergence agitation.

#E/N= number of patients with events/number of total patients, AD = arcsine-transformed difference, CI = confidence interval, SBP = systolic blood pressure.