Effect of Low-Dose Propofol Administered at the End of Sevoflurane Anesthesia on Emergence Agitation in Pediatric Patients Undergoing MRI: A Randomized Controlled Trial.

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.