13 6 13 3 The Journal of Evidence-ased Medicine Jun. 13 Vol.13 No.3 Meta 刘华, 阮林, 刘叶 ( 广西医科大学附属肿瘤医院麻醉科, 南宁 530021) [ ] PubMed ochrane EMASE (M) (VIP), 12 2, ochrane Handbook 5.0.1, RevMan 5.0 Meta 9, 840, 414, 426 Meta :,,,, [ ] / ; / ; ; Meta [ ] R614 [ ] A DOI:10.3969 / j.issn.1671-5144.13.03.012 Desflurane versus Sevoflurane in Pediatric Anesthesia: A Meta Analysis LIU Hua, RUAN Lin, LIU Ye (Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, hina) Abstract: Objective To evaluate the efficacy and adverse reactions of Desflurane versus Sevoflurane in pediatric anesthesia recovery. Methods We searched PubMed, the ochrane Library, EMASE, hinese iomedical Database (from establishment to February 12) for randomized controlled trials (RTs) about the efficacy and adverse reactions of Desflurane versus Sevoflurane in pediatric anesthesia recovery. Meta-analysis was conducted by RevMan 5.0 software. Result Nine RTs involving 840 patients were included. The result showed that the early recovery time was shorter in group of Desflurane. There were no significant differences in the postoperative recovery time, postoperative agitation and vomiting (PONV), severe pain and oculocardiac reflect (OR) between two groups. onclusion The limited current evidence shows that the effect of Desflurane is faster than Sevoflurane in early recovery time. The incidence of PONV of Desflurane is higher than Sevoflurane. Key words: Desflurane; Sevoflurane; pediatric anesthesia; meta-analysis Meta [1],, [ ] 广西自然科学基金资助项目 ( 桂科自 07280) [ ] 刘华 (1982-), 女, 河南商丘人, 在读硕士研究生, 研究方向为吸入麻醉 [ ] 阮林, Tel:0771-5333550; E-mail:1535943930 @qq.com
1 1.1 1.1.1 (randomized (odds ratio,or) 95%I controlled trial,rt);,, 16, I 2 <50%, ;,,, P<0.05 I 2 >50% 1.1.2,, (oculocardiac reflex,or) 1.2 PubMed ochrane EMASE (M) 159, 81 (VIP),, 9 12 2 desflurane sevoflurane pediatric anesthesia randomized controlled trial ; / [2,5,8] [2,5-8] /,5,, 9 1.3 1.3.1 2 [3-4,7-9], 2, 2.3 Meta 3 2.3.1,, 6 [2,5-7,9-10], :,, [2,6,9-10] 1 4, ;2 (P<0.05,I 2 >50%),, [WMD ;3 95%I -3.92(-6.25,-1.59),P<0.05], OR 1.3.2 ochrane 5.0.1 (,I 2 =0%),, [WMD 95%I :1 (, -2.55 (-3.32, -1.78),P <0.05],, );2 ;3 ( 2);3 [6-7,9],,, A ; (,I 2 =0%),,, ; [WMD 95%I -3.00,, (-3.66,-2.35),P<0.05],,. Meta 167 1.4 ochrane RevMan 5.0 Meta (weighted mean difference,wmd), 95% (confidence interval,i), 2 2.1 246,, [2-10] 1 2.2 9 3 9,4 [2,5-6,10],5 ( 1);2 [6,9], ( 2); 2
168 13 13 3 1 ( ) Demirbilek 04a [2] 30 30 5.2±1.4 5.0±1.6 Demirbilek 04b [2] 30 30 5.3±1.5 5.0±1.4 + + Isik 06 [3] 40 40 8.3±3.13 8.8±3.09 3 Ghoi 09a [4] Ghoi 09b [4] 34 33 35 35 4.7±1.8 5.3±1.8 4.9±2.1 5.2±1.9 + + 4 + + 4 Welborn 1996 [5] ohen 02 [6] Valley 03 [7] Oh 07 [8] ao 07 [9] Mayer 06 [10] 50 24 114 19 50 24 19 2±1.4 4.21±1.3 3.6±3.2 7.1 8.2±3.3 4.1±1.59 3±1.8 3.87±1.4 3.0±2.9 6.9 8.5±3.0 4.2±1.98 + + 4 13 1, 2, 3, 4 2 ITT Demirbilek 04 [2] Isik 06 [3] Ghoi 09 [4] Welborn 1996 [5] ohen 02 [6] Valley 03 [7] Oh 07 [8] ao 07 [9] Mayer 06 [10] 1 Meta [2,5], (P<0.05,I 2 >50%), (),, 2 [WMD 95% I -4.25 (-6.19, -2.31),P < 2.3.2 0.05], ( 3); ohen 5 [6], [2,5-7,10] Valley [7]
,. Meta 169 2 Meta 3 Meta, (,I 2 =0%), ();Welborn [5],, (P> [WMD 95% I -1.93 (-5.83, -1.98),P > 0.05);5 [2,5-7,10] 0.05], 4
170 13 13 3 4 Meta 2.3.3 7 95%I 1.04(0.66,1.62),], 6 [2-3,5-7,9-10] [2,5-7] 4, 3 (,I 2 =10%),, [OR 6, 95%I 2.11(1.19,3.76), P<0.05],, 4 ;7 [2-3,5-7,9-10], 3 (,I 2 =0%),, [OR 95%I 1.18(0.74,1.88),]; 2 (0.42) (0.67) ( 6) [2,6], (P>, 0.05,I 2 =0%), : [OR 95%I 0.92(0.53,1.60),], 5 2.3.4 (OR), [OR /, / [13],, [4,8] [14] 2 OR, (,I 2 =0%), /
,. Meta 171 5 ( ) Meta 6 (OR) Meta
172 13 13 3, /,[3] Isik Y, Goksu S, Kocoglu H, et al. Low flow Desflurane and Sevoflurane anaesthesia in children [J]. Eur J Anaesthesiol, 06,23(1):60-64. 3, [4] hoi SR, Park SW, Lee JH, et al. Effect of different 2 ( 6) anesthetic agents on oculocardiac reflex in pediatric strabismus, surgery [J]. J Anesth, 09,23(4):489-493. [5] Welborn LG, Hannallah RS, Norden JM, et al. ompairson of emergence and recovery characteristics of Sevoflurane, Desflurane, and Halothane in pediatric ambulatory patients [J]. Anesth Analg, 1996,83(5):917-9. [11] Vlajkovic [12] ohen IT, Juliac F, Raafat S, et al. The effect of Fentanyl on, 30, 5~ the emergence characteristics after Desflurane or Sevoflurane 15 anesthesia in children [J]. Anesth Analg, 02,94 (5):1178-, 1181. [15] [7] Valley RD, Freid E, ailey AG, et al. Tracheal extubation of deeply anesthetized pediatric patients: A comparison of, Desflurane and Sevoflurane [J]. Anesth Analg, 03,96(5): 13-1324. Wells [16] [8] Oh AY, Yun MJ, Kim HJ, et al. omparison of Desflurane, with Sevoflurane for the incidence of oculocardiac reflex in children undergoing strabismus surgery [J]. r J Anaesthesiol,, 07,99(2):262-265., [6] [9],,,. [J]., 07,9(3):188-189. OR [10] Mayer J, oldt J, Kerstin D, et al. Desflurane anesthesia, after Sevoflurane inhaled induction reduces severity of [17] emergence agitation in children undergoing minor ear-nosethroat, surgery compared with Sevoflurane induction and OR maintenance [J]. Pedtatr Anesth, 06,102(2):400-404. Oh [8] OR [11] Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale [J]. Anesthesiology, 04,100(5):1138-1145. : 1 9 [12] Vlajkovic G, Sindjelic R. Emergence delirium in children: Many questions, few answers [J]. Anesth Analg, 07,104,, 5 (1):84-91.,,4 [13],,,. ; 2 1 [J]., 1998, ± ;3 78(10):768-770. [14],,,. [J]., 05, 45(26):21-22. [15],,. [ ] [J]., 10,32(7):825-827. [1],. [J]. [16] Wells LT, Rasch DK. Emergence delirium after Sevoflurane [2], 06,2(3):239-240. Demirbilek S, Togal T, icek M, et al. Effects of Fentanyl anesthesia: A paranoid delusion [J]. Anesth Analg, 1999,88 (6):1308-1310. on the incidence of emergence agitation in children receiving Desflurane or Sevoflurane anaesthesia [J]. Eur J Anaesthesiol, 04, 21(7): 538-542. [17],. [M]. :, 02: 39-40. [ ] 12-06-24