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A literature review is a
*This sample paper was adapted by the UAGC Writing Center from Key, K. L., Rich, C.,
DeCristofaro, C., & Collins, S. (2010). Use of propofol and emergence
agitation in children: A literature review. AANA Journal, 78(6), 468-473.
Used with permission.
What is a Literature Review?
A literature review is a survey of scholarly sources that provides an
overview of a particular topic. It generally follows a discussion of the
paper’s thesis statement or the study’s goals or purpose.
Literature reviews are a collection of the most relevant and significant
publications regarding that topic in order to provide a comprehensive
look at what has been said on the topic and by whom.
Format your paper according to your assignment instructions: APA, MLA, Chicago Style
The following sample includes APA Style citations and references.
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Use of Propofol and Emergence Agitation inChildren: A Literature Review
Emergence agitation (EA) during recovery from general anesthesia has been
identified as a frequent problem in the pediatric population. In children, EA has been
described as a mental disturbance that consists of confusion, hallucinations, and delusions
manifested by moaning, restlessness, involuntary physical activity, and thrashing about in
bed (Sikich & Lerman, 2004). The overall rate for EA in children is in the range of 10% to
67% (Aouad & Nasr, 2005), which includes a period of severe restlessness, disorientation,
and/or inconsolable crying during anesthesia emergence (Cole et.al., 2002). The age at which
children are more likely to display signs of EA ranges from 2 to 5 years old and then begins
to decline at age 62 months (Pryzbylo et al., 2003). Additionally, the incidence of EA may
be affected by individual variations in developmental level within an age group, mental
disease, or neurologic conditions (Aouad & Nasr, 2005; Aouad et al, 2007; Bortone et al.,
2006). These age groups are defined by the American Academy of Pediatrics (2008) in its
Recommendations for Preventive Pediatric Health Care. Definitions are as follows: early
childhood (15 months to 4 years old), middle childhood (5 to 10 years old), and early
adolescence (11 to 12 years old). In this literature review, the most information was
available on EA in the age groups of early and middle childhood, with additional studies
that included early adolescents.
Clinical Factors Related to Development of Emergence Agitation
Populations studied for EA included the following characteristics: sex, age,
ethnicity, type and active psychological status, and ASA class. Most studies failed to
differ in male and female populations. Some studies did separate age cohort higher
rate of EA has been seen in preschool boys anesthetized with sevoflurane compared
Using headings, the literature
review can be organized by study
topic, building information about
the topic through definitive
academic contributions.
The
introduction
starts by
identifying the
topic.
The introduction
wraps up with a clear
thesis statement.
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with school-aged boys (Aouad & Nasr, 2005). The age of the child has been
considered to be a factor in the development of EA postoperatively, perhaps because
of the expected confusion and fright in this age group in response to perioperative
events. Aono et al. (1999) concluded that preschool-aged boys showed a higher rate
of emergence agitation than did school-aged boys when anesthetized with
sevoflurane. Voepel-Lewis et al. (2003) noted that young age and anxiety level
preoperatively were associated with EA. Many studies have confirmed that a younger
age is a contributing factor in the development of EA, and most studies now target
the ages of 2 through 6 years old when studying EA (Aouad & Nasr, 2005).
When EA was first described by Eckenoff in 1961, it was speculated that patients
were undergoing head and neck procedures may have a sense of suffocation during
emergence from anesthesia, thus increasing the chance of EA. Surgical procedures that
have been found to increase the risk of developing EA are otorhinolaryngology,
ophthalmology, and neck procedures, all of which may produce a sense of suffocation
(Aouad & Nasr, 2005; Vlajkovic & Sindjelic, 2007; Voepel-Lewis et al., 2003). The
length of surgery in at least one study was found to be a factor associated with
increased incidence of EA (Voepel-Lewis et al., 2003). In most studies, patients have
been excluded if they were above ASA classes I and II, which is one limitation of the
current literature (Baum et al., 1997). Exclusion criteria also included children with
psychological or emotional disorders, developmental delay, and patients who needed
sedative medication before induction (Abu-Shahwan, 2008).
Propofol TIVA techniques have also demonstrated a reduction in EA in children.
In the study by Cohen et al. (2003) of sevoflurane inhalational anesthesia versus a
It is important
to reference,
synthesize,
and cite other
research on
your topic.
Each subtopic has its
own thesis statement
that is then “proven”
through the review of
existing research.
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propofol TIVA technique, there were of EA in the sevoflurane group subtopic has its
own compared with the propofol group. In the study by Picard et al. (2000) then
“proven” through of the quality of recovery in children anesthetic and propofol research
publications. TIVA techniques were compared, with a reduction in EA rates observed in
the propofol TIVA group (46% versus 9%, respectively). A reduction in EA from 42% to
11% was seen in children 2 to 5 years of age with propofol TIVA compared with
sevoflurane inhalational general anesthesia (Nakayama et al., 2007).
The studies summarized in table A rates in sevoflurane alone, propofol TIVA
alone compared with findings that demonstrate that in researching either using
propofol adjunctively or using results in lower rates of EA compared with either
sevoflurane alone or sevoflurane with adjunctive propofol.
According to the literature evidence base, there is an advantage to either propofol
TIVA or adjunctive propofol with sevoflurane (compared with sevoflurane alone). We
conclude, based on the current evidence, that the use of propofol is associated with a
reduction in the incidence of emergence agitation.
Conclusion
The reviewed literature suggests that there are advantages to the use of propofol
TIVA techniques and adjunctive propofol anesthetics when combined with a sevoflurane
inhalational technique. This reduction in EA with propofol use in conjunction with or
separately from sevoflurane has been widely documented throughout the literature (Aouad
et al., 2007; Abu-Shahwan, 2008). A major limitation of this literature is that numerous EA
assessment scales are used to compare various anesthetics. If future studies use the same
validated assessment scale (such as the PAED), results can be more easily compared and
A literature review articulates the purpose of your
new project, which is to either fill a gap in current
research or to provide the next step in researching
the topic.
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strengthened. To better delineate the pathophysiology and causative factors regarding EA,
more structured and multicenter studies with larger populations should be performed.
Current research supports the use of propofol as discussed above; however, a continuation
of current research with consistent and strengthened methodologies will help justify its use
and application to clinical practice
The conclusion should be a succinct, oneparagraph reiteration of your literature review.
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References
Abu-Shahwan, I. (2008). Effect of Propofol on emergence behavior in children after
sevoflurane general anesthesia. Paediatric Anaesthesia, 18(1), 55–59.
https://doi.org/10.1111/j.1460-9592.2007.02376.x
American Academy of Pediatrics. (2019). Bright Futures/AAP Recommendations for
Preventive Pediatric Health Care (Periodicity Schedule). https://www.aap.org/enus/documents/periodicity_schedule.pdf
Aono, J., Mamiya, K., & Manabe, M. (1999). Preoperative anxiety is associated with a high
incidence of problematic behavior on emergence after halothane anesthesia in boys.
Acta Anaesthesiologica Scandinavica, 43(5), 542–544.
https://doi.org/10.1034/j.1399-6576.1999.430509.x
Aouad, M. T. & Nasr, V. G. (2005). Emergence agitation in children: an update. Current
Opinion in Anaesthesiology, 18(6), 614–619.
https://doi.org/10.1097/01.aco.0000188420.84763.35
Aouad, M. T., Yazbeck-Karam V. G., Nasr, V. G., El-Khatib, M. F., Kanazi G. E., & Bleik,
J. H. (2007). A single dose of propofol at the end of surgery for the prevention of
emergence agitation in children undergoing strabismus surgery during sevoflurance
anesthesia. Anesthesiology, 107(5), 733-738.
https://doi.org/10.1097/01.anes.0000287009.46896.a7
Baum, V. C., Yemen, T. A., & Baum, L. D. (1997). Immediate 8% sevoflurane induction
in children: a comparison with incremental sevoflurane and incremental halothane.
Anesthesia & Analgesia, 85(2), 313-316. https://doi.org/10.1097/00000539-
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Bortone, L., Ingelmo, P., Grossi, S., Grattagliano, C., Bricchi, C., Barantani, D., Sani, E.,
Mergoni, M. (2006). Emergence agitation in preschool children: double-blind,
randomized, controlled trial comparing sevoflurane and isoflurane anesthesia.
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9592.2006.01954.x
Cohen, I. T., Finkel, J. C., Hannallah, R. S., Hummer, K. A., & Patel, K. M. (2003). Rapid
emergence does not explain agitation following sevoflurane anaesthesia in infants
and children: A comparison with propofol. Paediatric Anaesthesia, 13(1), 63–67.
https://doi.org/10.1046/j.1460-9592.2003.00948.x
Cole, J. W., Murray, D. J., McAllister, J. D., & Hirshberg, G.E. (2002). Emergence
behaviour in children: defining the incidence of excitement and agitation following
anaesthesia. Paediatric Anaesthesia, 12(5), 442. https://doi.org/10.1046/j.1460-
9592.2002.00868.x
Eckenhoff, J. E., Kneale, D. H., & Dripps, R.D. (1961). The incidence and etiology of
postanesthetic excitement: A clinical survey. Anesthesiology, 22, 667–673.
https://doi.org/10.1097/00000542-196109000-00002
Nakayama, S., Furukawa, H., & Yanai, H. (2007). Propofol reduces the incidence of
emergence agitation in preschool-aged children as well as in school-aged children:
A comparison with sevoflurane. Journal of Anesthesia, 21(1), 19–23.
https://doi.org/10.1007/s00540-006-0466-x
Picard, V., Dumont, L., & Pellegrini, M. (2000). Quality of recovery in children:
Sevoflurane versus propofol. Acta Anaesthesiologica Scandinavica, 44(3), 307–
310. https://doi.org/10.1097/00000539-200009000-00012
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Przybylo, H. J., Martini, D. R., Mazurek, A. J., Bracey, E., Johnsen, J., & Cote, C. J.
(2003). Assessing behaviour in children emerging from anaesthesia: can we apply
psychiatric diagnostic techniques? Paediatric Anaesthesia, 13(7), 609.
https://doi.org/10.1046/j.1460-9592.2003.01099.x
Sikich, N., & Lerman, J. (2004). Development and psychometric evaluation of the pediatric
anesthesia emergence delirium scale. Anesthesiology: The Journal of the American
Society of Anesthesiologists, 100(5), 1138-1145. https://doi.org/10.1097/00000542-
200405000-00015
Vlajkovic, G. P., & Sindjelic, R. P. (2007). Emergence delirium in children: Many
questions, few answers. Anesthesia & Analgesia, 104(1), 84–91.
https://doi.org/10.1213/01.ane.0000250914.91881.a8
Voepel-Lewis, T., Malviya, S., & Tait, A. R. (2003). A prospective cohort study of
emergence agitation in the pediatric postanesthesia care unit. Anesthesia &
Analgesia, 96(6), 1625-1630. https://doi.org/10.1213/01.ane.0000062522.21048.61