OPTIMIZING ANESTHESIA DELIVERY IN PEDIATRIC PATIENTS: A COMPARATIVE STUDY OF INHALATIONAL VS. INTRAVENOUS AGENTS
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Abstract
General anesthesia is essential for pediatric inpatient surgery and can be induced and maintained using either intravenous or volatile anesthetic agents. This study aimed to determine the superior approach in preventing anesthesia-related complications. Using a predefined standardized protocol, we conducted a systematic review of randomized controlled trials (RCTs) from CENTRAL, MEDLINE, EMBASE, and metaRegister of Controlled Trials. Eligible RCTs compared adverse effects of intravenous versus volatile anesthetic agents in pediatric inpatients. Primary endpoints included cardiopulmonary complications, postoperative nausea and vomiting (PONV), or cognitive dysfunction within 24 hours post-anesthesia. Secondary endpoints encompassed other complications. Nine RCTs (762 children) were analyzed. Propofol use during strabismus surgery significantly increased oculocardiac reflex risk (RR 4.96, 95% CI: 3.13–7.87, p < 0.00001; two studies, 257 children). PONV was less frequent with intravenous compared to volatile anesthetic agents (RR 0.68, 95% CI: 0.48–0.98, p = 0.04; five studies, 563 children). No further significant differences were identified in primary or secondary endpoints due to clinical or statistical heterogeneity. Propofol heightened oculocardiac reflex risk, whereas PONV occurred less frequently with intravenous anesthetics than with volatile agents in pediatric general anesthesia. These findings may guide tailored anesthesia strategies for pediatric inpatients. Given existing heterogeneity among studies, further scientific efforts are warranted to enhance evidence on anesthetic agent selection in pediatric anesthesia.