Relationship between perioperative medications and risk of emergence agitation in children after sevoflurane anesthesia: a network meta-analysis.
Saihao Fu, Mengrong Miao, Jing Bian, Yunxiang Fu, Jiaqiang Zhang, Mingyang Sun
Pediatric research January 27, 2026 DOI: 10.1038/s41390-026-04781-3 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and network meta-analysis Peer reviewed |
|---|---|
| Sample size | 7,617 |
| Population | Children after sevoflurane anaesthesia |
| Interventions | sufentanil esketamine dexmedetomidine nalbuphine tropisetron ketamine magnesium sulphate propofol fentanyl remifentanil midazolam |
| Citations | 1 |
| Key findings | Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine significantly reduced the incidence of emergence agitation in children. |
Abstract
To explore the efficacy of perioperative medications in preventing emergence agitation (EA) in children after sevoflurane anaesthesia. 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. 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. Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine showed favourable EA-preventing effects in children. CRD42023470892. 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.