Author: Shen, Fangming et al.
Anesthesiology. August 2025. doi:10.1097/ALN.0000000000005707
This multicenter randomized clinical trial (AmPRAEC) studied 760 children (ages 0–12) undergoing adenotonsillectomy across 12 hospitals in China. Patients were randomized to intravenous anesthesia maintenance with propofol (IV group), combined intravenous–inhalation anesthesia (IVIH group), or inhalation anesthesia alone (IH group). All underwent tracheal intubation and awake extubation. The primary endpoint was postoperative respiratory adverse events (PRAEs) in the recovery unit.
Results demonstrated a clear benefit of propofol use. PRAEs occurred in 43.4% of children in the IH group, 28.5% in the IVIH group, and only 18.8% in the IV group. Compared to inhalation alone, combined IVIH lowered PRAE risk (aOR 0.44; NNT 7), while IV propofol alone had the greatest benefit (aOR 0.25; NNT 3). Propofol-only was also superior to IVIH (aOR 0.57; NNT 6).
The findings support intravenous propofol maintenance as the most effective approach to reduce PRAEs in pediatric adenotonsillectomy.
What you should know:
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Propofol-only anesthesia had the lowest incidence of respiratory complications.
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Adding propofol to inhalation improved outcomes compared with inhalation alone.
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The number needed to treat (NNT) was low, suggesting strong clinical impact.
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This trial reinforces the safety advantage of propofol in pediatric airway surgery.
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