Sophia M Blaauwendraad, Lucy L Porter, Barbe M Pieters. Respiratory and Haemodynamic Perioperative Adverse Events in Intravenous Versus Inhalational Induction in Paediatric Anaesthesia: A Systematic Review and Meta-Analysis.
Paediatr Anaesth. 2020 May 1. doi: 10.1111/pan.13904. Online ahead of print. PMID: 32358815

Abstract

Perioperative respiratory and haemodynamic adverse events are still a cause of morbidity and mortality in paediatric anaesthesia. It has been suggested that volatile agents might be associated with more respiratory adverse events compared to intravenous agents (e.g., propofol), which have been associated with a higher risk of bradycardia compared to volatile agents. We performed a systematic review and meta-analysis to evaluate the risk of perioperative haemodynamic and respiratory adverse events, comparing intravenous induction with inhalational induction in paediatric anaesthesia. We searched PubMed, Embase and Medline up to February 12th , 2020. Randomized controlled trials were included. A quality assessment was carried out using a modified version of the ‘Cochrane Risk of Bias Tool for Randomized Controlled Trials.’ Of the 1,602 applicable publications, four were included in the final review. Two studies found no significant differences in perioperative respiratory or haemodynamic adverse events. Two studies found a higher risk of respiratory perioperative adverse events in inhalation versus intravenous induction, with a relative risk varying from 1.64 to 3.83. Data was heterogenous and pooled estimates may not be reliable. The present systematic review and meta-analysis revealed no significant difference in the occurrence of perioperative respiratory adverse events between inhalation and intravenous induction. More respiratory adverse events during and after inhalation induction were found, in particular in children with multiple risk factors for respiratory adverse events. This did not reach significance. Future research should include a large randomized controlled trial comparing inhalation and intravenous induction with respiratory and haemodynamic adverse events as primary outcome and adequately blinded outcome assessors.