Effect of Low‐Dose Propofol Administered at the End of Sevoflurane Anesthesia on Emergence Agitation in Pediatric Patients Undergoing MRI: A Randomized Controlled Trial
Abstract
Background Emergence agitation (EA) is a common postanesthetic problem in pediatric patients, particularly with sevoflurane anesthesia, and may lead to injury to patients, prolonged postanesthesia care unit (PACU) stay, and a risk of long‐term maladaptive behavioral changes. Evidence regarding EA in nonpainful procedures such as magnetic resonance imaging (MRI) remains inconclusive. This study evaluated the effect of low‐dose propofol at the end of sevoflurane anesthesia on EA in pediatric patients undergoing MRI. Methods In this randomized controlled trial, 130 pediatric patients aged 2–8 years undergoing MRI under sevoflurane anesthesia with a laryngeal mask airway were enrolled. Patients were randomly assigned to receive either Group P (n = 61), receiving intravenous propofol 0.5 mg/kg, or Group N (n = 61), receiving normal saline at the end of anesthesia. EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, with EA defined as a score > 12 within the first 30 min of PACU stay. Primary analysis was performed on a per‐protocol approach (n = 122), alongside a sensitivity analysis using the intention‐to‐treat approach (n = 130). Secondary outcomes included emergence time, PACU stay, adverse events, and requirement for EA rescue medication. Results In the per‐protocol analysis (n = 122), the incidence of EA was significantly lower in Group P compared with Group N (18.0% vs 39.3%; p = 0.01), with a relative risk of 0.46 (95% CI 0.25–0.85). Emergence time, PACU stay, adverse events, and requirement of EA rescue medication were comparable between the two groups. Conclusions Administration of propofol at a dose of 0.5 mg/kg at the end of sevoflurane anesthesia significantly reduces EA in pediatric patients undergoing MRI without prolonging recovery or increasing adverse events. Further large‐scale, multicenter studies are warranted to confirm efficacy and evaluate safety. Trial Registration: ClinicalTrials.gov identifier: NCT06218680