Comparing different administration methods of subanaesthetic propofol to mitigate emergence agitation in preschool children undergoing day surgery: a double-blind, randomised controlled study.

Summary

In 160 preschool children undergoing day-case laparoscopic inguinal hernia repair with sevoflurane, a 3-minute continuous infusion of propofol 1 mg/kg at case end reduced emergence agitation to 5% versus 30–65% with other strategies, without prolonging extubation or emergence times. Peak PAED scores were lowest with continuous infusion.

Key Findings

• Emergence agitation incidence dropped to 5% with 3-minute continuous infusion of propofol 1 mg/kg versus 30–65% in control or bolus groups.
• Peak PAED scores were significantly lower in the continuous infusion group.
• Extubation and emergence times did not differ among groups, indicating no recovery delay.

Clinical Implications

For preschool children anesthetized with sevoflurane, consider a 3-minute continuous infusion of propofol 1 mg/kg at the end of surgery to minimize emergence agitation without impacting time to extubation.

Limitations

• Single procedure type and single anesthetic (sevoflurane) in a single-center study
• Short-term outcomes without behavioral follow-up beyond early recovery

Future Directions

Replicate across procedures, anesthetic regimens, and settings; evaluate dose–response, safety in higher-risk children, and longer-term behavioral outcomes.