Twenty-three studies were included (n=1,252 sevoflurane and n=1,111 halothane), most of which were of high quality (median score 5, range 2-6). There was no significant heterogeneity between studies and no evidence of publication bias.
The pooled OR (23 studies) of emergence agitation with sevoflurane was 2.21 (95% CI: 1.77, 2.77, p<0.0001), indicating that sevoflurane anaesthesia more often resulted in emergence agitation than halothane.
Sensitivity analysis using only high-quality studies (14 studies) yielded an OR of emergence agitation with sevoflurane of 1.82 (95% CI: 1.37, 2.41, p<0.0001).
Subgroup analyses for patients younger than seven years of age (11 studies) gave an OR of 1.88 (95% CI: 1.39, 2.54, p=0.0001). For those where the study protocol included routine premedication (12 studies) the OR was 1.77 (95% CI: 1.26, 2.47, p=0.0009). For myringotomy insertion studies (six studies) the OR was 1.79 (95% CI: 1.26, 2.53, p=0.001). For those with pain-treated inguinal surgery (five studies) the OR was 3.20 (95% CI: 1.65, 6.22, p=0.0006).