Purpose To explore the efficacy of perioperative medications in preventing emergence agitation (EA) in children after sevoflurane anaesthesia. Methods This network meta-analysis used a frequency-analysis model. PubMed, Embase, Cochrane Library, Web of Science, Google Scholar and ClinicalTrials.gov databases were searched from inception to March 11, 2023. Results A total of 19 drugs were analysed in 70 studies involving 7617 participants. In the cumulative ranking area under the curve (SUCRA) analysis, sufentanil, esketamine, dexmedetomidine, nalbuphine, tropisetron, ketamine, magnesium sulphate, propofol, fentanyl, remifentanil, and midazolam showed significant EA-preventing effects. Further direct comparisons between the drugs and the control group revealed that fentanyl (Log OR = −1.28, 95% CI −1.76, −0.80, P < 0.001), ketamine (Log OR = −1.77, 95% CI −2.45, −1.10, P < 0.001), dexmedetomidine (Log OR = −1.60, 95% CI −1.88, −1.33, P < 0.001), midazolam (Log OR = -0.96, 95% CI −1.34, −0.57, P < 0.001), propofol (Log OR = −1.34, 95% CI −1.83, −0.85, P < 0.001), and nalbuphine (Log OR = −1.32, 95% CI −1.66, −0.98, P < 0.001) significantly reduced the incidence of EA in children. Conclusion Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine showed favourable EA-preventing effects in children. Registration number CRD42023470892. Impact <UnorderedList Mark="Bullet"> <ItemContent> This review provides a detailed network meta-analysis comparing 19 perioperative medications, offering a ranked efficacy profile (via SUCRA analysis) for preventing emergence agitation (EA) in children after sevoflurane anaesthesia, which consolidates and expands upon previous pairwise comparisons. </ItemContent> </UnorderedList> <UnorderedList Mark="Bullet"> <ItemContent> It identifies dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine as the most effective drugs for EA prevention, supporting evidence-based decision-making in paediatric anaesthesia practice. </ItemContent> </UnorderedList>

Relationship between perioperative medications and risk of emergence agitation in children after sevoflurane anesthesia: a network meta-analysis

期刊论文
发表日期：

2026年1月27日

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Saihao Fu,
Mengrong Miao,
Jing Bian,
Yunxiang Fu,
Jiaqiang Zhang,
Mingyang Sun

摘要

Purpose

To explore the efficacy of perioperative medications in preventing emergence agitation (EA) in children after sevoflurane anaesthesia.

Methods

This network meta-analysis used a frequency-analysis model. PubMed, Embase, Cochrane Library, Web of Science, Google Scholar and ClinicalTrials.gov databases were searched from inception to March 11, 2023.

Results

A total of 19 drugs were analysed in 70 studies involving 7617 participants. In the cumulative ranking area under the curve (SUCRA) analysis, sufentanil, esketamine, dexmedetomidine, nalbuphine, tropisetron, ketamine, magnesium sulphate, propofol, fentanyl, remifentanil, and midazolam showed significant EA-preventing effects. Further direct comparisons between the drugs and the control group revealed that fentanyl (Log OR = −1.28, 95% CI −1.76, −0.80, P < 0.001), ketamine (Log OR = −1.77, 95% CI −2.45, −1.10, P < 0.001), dexmedetomidine (Log OR = −1.60, 95% CI −1.88, −1.33, P < 0.001), midazolam (Log OR = -0.96, 95% CI −1.34, −0.57, P < 0.001), propofol (Log OR = −1.34, 95% CI −1.83, −0.85, P < 0.001), and nalbuphine (Log OR = −1.32, 95% CI −1.66, −0.98, P < 0.001) significantly reduced the incidence of EA in children.

Conclusion

Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine showed favourable EA-preventing effects in children.

Registration number

CRD42023470892.

Impact

This review provides a detailed network meta-analysis comparing 19 perioperative medications, offering a ranked efficacy profile (via SUCRA analysis) for preventing emergence agitation (EA) in children after sevoflurane anaesthesia, which consolidates and expands upon previous pairwise comparisons.

It identifies dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine as the most effective drugs for EA prevention, supporting evidence-based decision-making in paediatric anaesthesia practice.