Comparison analysis of safety profiles and identification of risk factors for postoperative adverse reactions: propofol versus sevoflurane in pediatric anesthesia

Abstract

Objective: To compare the safety profiles between propofol and sevoflurane in pediatric anesthesia and to investigate risk factors for postoperative adverse reactions.

Methods: The data of 194 children who received surgical treatment in Peking Union Medical College Hospital between January 2019 and May 2022 were analyzed retrospectively. According to the different anesthetic drugs the children received, they were divided into a control group (conventional anesthesia with sevoflurane, n=94) and an observation group (anesthesia with both propofol and sevoflurane, n=100). The two groups were compared in terms of anesthetic effect, heart rate, blood oxygen saturation, Ramsay sedation scale (RSS) score during the recovery of anesthesia, and anesthesia safety. Further, the children were grouped based on RSS score to identify the risk factors for agitation during the recovery of anesthesia via logistics regression.

Results: The onset time of anesthesia, spontaneous breathing recovery time, extubation time, eye opening time and awake time in the observation group were all significantly shorter than those in the control group (P<0.05). At T1 (during anesthesia induction), T2 (after tracheal intubation) and T3 (after extubation), the observation group showed relatively stable heart rate and blood oxygen saturation than the control group (P<0.05). At the time of awakening, extubation and 30 minutes after extubation, the observation group exhibited significantly lower RSS score than the control group (P<0.05). The observation group also showed a significantly lower incidence of nausea, vomiting and agitation than the control group (P<0.05). Additionally, age ≤6 years old and anesthesia scheme were independent risks for agitation in children during the recovery of anesthesia. The occurrence group had significantly higher risk scores than the non-occurrence group (P<0.05). According to receiver operating characteristic curve-based analysis, the area under the curve of risk score in predicting agitation during the recovery of anesthesia was 0.733.

Conclusion: Anesthesia with both propofol and sevoflurane is effective in children undergoing surgical treatment, because the combination can substantially reduce the agitation of children during the recovery of anesthesia and has high anesthesia safety. Propofol combined with sevoflurane is a protective factor against agitation in children during the recovery of anesthesia.

Keywords: Propofol; adverse reactions; agitation during the recovery of anesthesia; pediatric anesthesia; sevoflurane.

Figure 1

Comparison of anesthetic effect between the observation group and control group. A: Comparison of the onset time of anesthesia; B: Comparison of spontaneous breathing recovery time; C: Comparison of extubation time; D: Comparison of eye opening time; E: Comparison of awake time. Note: ****P<0.0001.

Figure 2

Comparison of heart rate and blood oxygen saturation at different time points. A: Comparison of heart rate; B: Comparison of oxygen saturation. Note: HR: heart rate. ****P<0.0001.

Figure 3

Comparison of RRS and VAS scores between the observation group and control group. A: Comparison of RRS score; B: Comparison of VAS score. Note: ***P<0.001, ****P<0.0001. RSS: Ramsay sedation scale; VAS: Visual analogue scale.

Figure 4

The value of risk model in predicting agitation during the recovery of anesthesia. A: The risk score in children with agitation during the recovery of anesthesia; B: ROC curve of the risk score; C: Risk model correction curve. Notes: ROC: receiver operating characteristic; ****P<0.0001.