{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:54:04Z","timestamp":1788364444052,"version":"build-2803163510"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:00:00Z","timestamp":1702425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta\u2010analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta\u2010analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta\u2010analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an updated systematic review and meta\u2010analysis of clinical trials comparing sevoflurane to isoflurane in children &lt;18\u2009years of age, reporting emergence agitation as an outcome, published before July 2023 using databases and registers. Our primary outcome was the incidence of emergence agitation. Secondary outcomes were time to extubation, awakening time, and length of stay in the postanesthetic care unit. We assessed the risk of bias using the Cochrane Risk of Bias tool version 2. We pooled the effect size for the outcomes using the fixed effects model if we had low heterogeneity, otherwise, we used a random\u2010effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight randomized controlled trials (523 children) were included in the final analysis. The incidence of emergence agitation after isoflurane was significantly lower compared to sevoflurane (risk ratio: 0.62 (95% CI: [0.46\u20130.83]; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200940.01%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001)). Time to extubation, awakening times, and postanesthetic care unit duration were not significantly different. The protective effect of isoflurane compared to sevoflurane remained significant in subgroups of patients who received premedication or intraoperative systemic analgesics (risk ratios: (0.48 [0.28\u20130.82]; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200960.78%, <jats:italic>p<\/jats:italic>\u2009=\u2009.01), (0.52 [0.37\u20130.75]; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.00%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14819","type":"journal-article","created":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T10:26:28Z","timestamp":1702549588000},"page":"304-317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Incidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An\u00a0updated systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2691-0032","authenticated-orcid":false,"given":"Rasha S.","family":"Farag","sequence":"first","affiliation":[{"name":"Division of Medical Critical Care Boston Children's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Clinical Research, Damietta Directorate for Health Affairs Egyptian Ministry of Health and Population  Damietta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-0565","authenticated-orcid":false,"given":"Aaron C.","family":"Spicer","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1442-195X","authenticated-orcid":false,"given":"Geetha","family":"Iyer","sequence":"additional","affiliation":[{"name":"Postdoctoral Fellow, Department of Epidemiology Harvard TH Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9880-9662","authenticated-orcid":false,"given":"Jennifer P.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Center for Healthcare Delivery Science Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"King","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4257-2467","authenticated-orcid":false,"given":"Paul A.","family":"Bain","sequence":"additional","affiliation":[{"name":"Countway Library of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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