{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T07:11:58Z","timestamp":1778569918250,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Laryngospasm is defined as glottis closure due to reflex constriction of the laryngeal muscles. It is one of the most common complications following pediatric anesthesia that can lead to hypoxemia, bradycardia, or aspiration. Laryngospasm following tracheal extubation has different reasons: presence of secretions, foreign body in the airway, or pain at the site of surgery. Propofol is usually used as an induction or maintenance agent. However, its use with the subhypnotic dose (0.5 mg\/kg) is increasing nowadays for reducing the incidence of laryngospasm. This systematic review and meta-analysis aim to assess the efficacy of subhypnotic propofol in reducing the incidence of laryngospasm and respiratory complications in children following tonsillectomy or adenotonsillectomy and before extubation. Methods: We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they used propofol with a low dose (0.5 mg\/kg) following tonsillectomy and before extubation. Both Randomized Controlled Trials (RCTs) and cohort studies published up until 27 December 2025 were included. We used the R software for statistical analysis. We employed a random-effects model for the analysis. Continuous outcomes were analyzed as mean differences (MD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics. Results: Our review included four RCTs and one prospective cohort study with 593 participants. Our analysis showed that propofol was significantly associated with a low incidence of laryngospasm (RR = 0.25, 95% CI 0.13\u20130.49), cough (RR = 0.08, 95% CI 0.01\u20130.62), and agitation (RR = 0.15, 95% CI 0.03\u20130.72) compared with the control group. However, there were no significant differences regarding laryngeal occlusion (RR = 0.70, 95% CI 0.20\u20132.46), cyanosis (RR = 1.13, 95% CI 0.14\u20139.43), stridor (RR = 1.38, 95% CI 0.76\u20132.50), and the duration of surgery (MD = 1.81, 95% CI \u22120.74 to 4.36). Conclusions: Our findings state that propofol had a lower significant incidence of laryngospasm than the control. Trial sequential analysis for laryngospasm indicated that evidence is conclusive. However, regarding the other outcomes, the evidence is still inconclusive, which suggests the need for future large-scale RCTs with larger sample sizes to validate these findings.<\/jats:p>","DOI":"10.3390\/jcm15052074","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T10:16:12Z","timestamp":1773051372000},"page":"2074","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Subhypnotic Dose of Propofol on Respiratory Adverse Events Following Postoperative Tonsillectomy\/Adenotosillecomy: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4113-9258","authenticated-orcid":false,"given":"Noof","family":"Albannai","sequence":"first","affiliation":[{"name":"School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Esmaeel","sequence":"additional","affiliation":[{"name":"School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Alsaif","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City P.O. 1793, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fajer","family":"Alabdulrazzaq","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization, Kuwait City P.O. 1793, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salman","family":"Alshammari","sequence":"additional","affiliation":[{"name":"School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebrahim","family":"Almulla","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Tallaght University Hospital, D24 NR0A Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2464-4068","authenticated-orcid":false,"given":"Shawkat","family":"Abdulrahman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Tallaght University Hospital, D24 NR0A Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","first-page":"S49","article-title":"Extubation and removal of supraglottic airway devices in pediatric anesthesia","volume":"19","author":"Igarashi","year":"2024","journal-title":"APM"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/bja\/aer058","article-title":"Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia","volume":"106","author":"Cook","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e44598","DOI":"10.1097\/MD.0000000000044598","article-title":"Postoperative respiratory adverse events in pediatric anesthesia: Risk factors, clinical implications, and management strategies","volume":"104","author":"Li","year":"2025","journal-title":"Medicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.bjan.2017.03.009","article-title":"Low dose propofol vs. lidocaine for relief of resistant post-extubation laryngospasm in the obstetric patient","volume":"68","author":"Mokhtar","year":"2018","journal-title":"Braz. J. Anesthesiol. Elsevier"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e20170009","DOI":"10.1542\/peds.2017-0009","article-title":"Upper Respiratory Infections and Airway Adverse Events in Pediatric Procedural Sedation","volume":"140","author":"Mallory","year":"2017","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/S0140-6736(16)31719-6","article-title":"The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: A randomised controlled trial","volume":"389","author":"Ramgolam","year":"2017","journal-title":"Lancet Lond. Engl."},{"key":"ref_7","first-page":"3706106","article-title":"Incidence and Associated Factors of Laryngospasm among Pediatric Patients Who Underwent Surgery under General Anesthesia, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: A Cross-Sectional Study","volume":"2020","year":"2020","journal-title":"Anesthesiol. Res. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5147","DOI":"10.1007\/s12070-021-03037-2","article-title":"The Effect of Low-Dose of Propofol on the Respiratory Complications Immediately After Tracheal Extubation in Children Undergoing Tonsillectomy","volume":"74","author":"Hosseini","year":"2022","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103","DOI":"10.4103\/0019-5049.199855","article-title":"Anaesthesia for adenotonsillectomy: An update","volume":"61","author":"Bangera","year":"2017","journal-title":"Indian J. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1038\/nchembio.1340","article-title":"A propofol binding site on mammalian GABAA receptors identified by photolabeling","volume":"9","author":"Yip","year":"2013","journal-title":"Nat. Chem. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2024.0431","article-title":"Impact of Propofol Administered before Extubation on Respiratory Adverse Events in Pediatric Patients Undergoing Tonsillectomy and Adenoidectomy: A Randomized Controlled Trial","volume":"85","author":"Liao","year":"2024","journal-title":"Br. J. Hosp. Med."},{"key":"ref_12","unstructured":"Folino, T.B., Muco, E., Safadi, A.O., and Parks, L.J. (2026, January 01). Propofol, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430884\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"10581","DOI":"10.4081\/ejtm.2022.10581","article-title":"Propofol versus lidocaine on prevention of laryngospasm in tonsillectomy: A randomized clinical trial","volume":"32","author":"Manouchehrian","year":"2022","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_14","first-page":"4","article-title":"The Preventive Effect of Subhypnotic Dose of Propofol in Preventing Laryngospasm in Children undergoing Adeno-tonsillectomy in Addis Ababa Hospitals, Addis Ababa Ethiopia","volume":"5","author":"Gebeyehu","year":"2021","journal-title":"A Prospect. Cohort Study J. Surg. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/j.1460-9592.2005.01633.x","article-title":"The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children","volume":"15","author":"Batra","year":"2005","journal-title":"Pediatr. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_17","first-page":"ED000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"520","DOI":"10.5195\/jmla.2021.1260","article-title":"EndNote 20 desktop version","volume":"109","author":"Gotschall","year":"2021","journal-title":"J. Med. Libr. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_21","unstructured":"Wells, G., O\u2019connell, D., and Peterson, J. (2000). The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis, Ottawa Hospital Research Institute."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_23","unstructured":"R Core Team (2025). R: A Language and Environment for Statistical Computing, The R Core Team. Available online: https:\/\/www.R-project.org."},{"key":"ref_24","unstructured":"(2025, November 22). RStudio Builds. 2024.12.1+563.pro5. Available online: https:\/\/dailies.rstudio.com\/version\/2024.12.1+563.pro5\/."},{"key":"ref_25","first-page":"470","article-title":"Bias in meta-analysis detected by a simple, graphical test. Graphical test is itself biased","volume":"316","author":"Irwig","year":"1998","journal-title":"BMJ"},{"key":"ref_26","first-page":"195","article-title":"A new improved graphical and quantitative method for detecting bias in meta-analysis","volume":"16","author":"Barendregt","year":"2018","journal-title":"JBI Evid. Implement."},{"key":"ref_27","first-page":"89","article-title":"A nonparametric \u201ctrim and fill\u201d method of accounting for publication bias in meta-analysis","volume":"95","author":"Duval","year":"2000","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_28","unstructured":"Thorlund, K., Engstr\u00f8m, J., Wetterslev, J., Brok, J., Imberger, G., and Gluud, C. (2011). User Manual for Trial Sequential Analysis (TSA), Copenhagen Trial Unit. [2nd ed.]. Available online: https:\/\/www.ctu.dk\/wp-content\/uploads\/2021\/03\/2017-10-10-TSA-Manual-ENG_ER.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1213\/ANE.0000000000003430","article-title":"Rates of Perioperative Respiratory Adverse Events Among Caucasian and African American Children Undergoing General Anesthesia","volume":"127","author":"Tariq","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S2213-2600(17)30116-9","article-title":"Incidence of severe critical events in paediatric anaesthesia (APRICOT): A prospective multicentre observational study in 261 hospitals in Europe","volume":"5","author":"Habre","year":"2017","journal-title":"Lancet Respir. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wudineh, D.M., Berhe, Y.W., Chekol, W.B., Adane, H., and Workie, M.M. (2022). Perioperative Respiratory Adverse Events Among Pediatric Surgical Patients in University Hospitals in Northwest Ethiopia; A Prospective Observational Study. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.827663"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3892\/etm.2023.11985","article-title":"Effect of dexmedetomidine on preventing perioperative respiratory adverse events in children: A systematic review and meta-analysis of randomized controlled trials","volume":"25","author":"Zhang","year":"2023","journal-title":"Exp. Ther. Med."},{"key":"ref_33","first-page":"e6427","article-title":"Effect of Pharmacological Agents Administered for Attenuating the Extubation Response on the Quality of Extubation: A Systematic Review","volume":"11","author":"Salim","year":"2019","journal-title":"Cureus"},{"key":"ref_34","first-page":"10732","article-title":"Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy","volume":"32","author":"Manouchehrian","year":"2022","journal-title":"Eur. J. Transl. Myol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1007\/s00540-024-03453-y","article-title":"Prophylactic pharmacological interventions against perioperative respiratory adverse events in children undergoing noncardiac surgery: A systematic review and meta-analysis","volume":"39","author":"Deng","year":"2025","journal-title":"J. Anesth."},{"key":"ref_36","unstructured":"Cullen, B.F., Stock, M.C., Ortega, R., Sharar, S.R., Holt, N.F., Connor, C.W., and Nathan, N. (2024). Barash, Cullen, and Stoelting\u2019s Clinical Anesthesia, Lippincott Williams & Wilkins. [9th ed.]."},{"key":"ref_37","unstructured":"Beecham, G.B., Nessel, T.A., and Goyal, A. (2026, January 02). Lidocaine, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK539881\/."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/pan.70077","article-title":"Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia: A Systematic Review and Meta-Analysis","volume":"36","author":"Weba","year":"2025","journal-title":"Pediatr. Anesth."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jclinane.2016.06.025","article-title":"Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: A randomized, double-blind, placebo-controlled trial","volume":"35","author":"Ozturk","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1007\/s12630-023-02401-w","article-title":"Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: A randomized controlled trial","volume":"70","author":"Ouellet","year":"2023","journal-title":"Can. J. Anesth. Can. Anesth."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1111\/anae.12788","article-title":"The efficacy of lidocaine to prevent laryngospasm in children: A systematic review and meta-analysis","volume":"69","author":"Mihara","year":"2014","journal-title":"Anaesthesia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/2074\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T10:48:27Z","timestamp":1773053307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/2074"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15052074"],"URL":"https:\/\/doi.org\/10.3390\/jcm15052074","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}