1. Effective Ineffective
Propofol* Desflurane Fentanyl* Isoflurane Dexmedetomidine* Oral Midazolam premedication Clonidine* Parental presence at emergence Halothane* Gradual sevo cessation Ketamine Lower sevo concentration IV Midazolam at end Analgesia Various sedatives N2O washout

2. The Big 3 RR Propofol (TIVA) 0.35 Fentanyl 0.37 Dexmedetomidine
Studies
Participants RR
95% CI
Propofol (TIVA) 14
1098
0.35
0.25, 0.51
Fentanyl 15
1247
0.37
0.27, 0.50
Dexmedetomidine 12
851
0.29, 0.47
RR = relative risk of EA

3. Approach for Calm Emergence (Use any combination of the options below, always context specific, individualised to the patient)
Propofol (emerge on propofol)
options: TIVA, maintenance, transition late, or bolus at end
Adequate analgesia at emergence
including fentanyl (nasal fentanyl 2mcg/kg if no IV cannula)
+/- alpha2 agonist (premed or IV) either dexmedetomidine or clonidine
If using N2O, then use N2O to washout sevo at end