Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 26;14(5):1586.
doi: 10.3390/jcm14051586.

A Meta-Analysis of the Impact of Intranasal Dexmedetomidine on Emergence Delirium and Agitation in Children and Adolescents Undergoing Tonsillectomy and/or Adenoidectomy

Abbas Al Mutair  1 , Yasmine Alabbasi  2 , Bushra Alshammari  3 , Awatif M Alrasheeday  4 , Hanan F Alharbi  2 , Abdulsalam M Aleid  5
Affiliations

A Meta-Analysis of the Impact of Intranasal Dexmedetomidine on Emergence Delirium and Agitation in Children and Adolescents Undergoing Tonsillectomy and/or Adenoidectomy

Abbas Al Mutair et al. J Clin Med. .

Abstract

Background: Tonsillectomy and adenoidectomy are two common pediatric operations that are frequently associated with postoperative problems like emergence agitation (EA) and emergence delirium (ED). Intranasal dexmedetomidine, which has anxiolytic and sedative qualities with low respiratory effects, is becoming increasingly popular as a premedication in pediatric patients. However, there is limited evidence on its efficacy in tonsillectomy and/or adenoidectomy. This original research is a meta-analysis examining the impact of intranasal dexmedetomidine on EA, ED, and other perioperative outcomes in children having these procedures. Methods: A thorough search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was performed for randomized controlled trials (RCTs) published by January 2025 of select studies on children undergoing tonsillectomy and/or adenoidectomy. The intervention was intranasal dexmedetomidine (1-2 µg/kg), whereas the comparator was placebo/no intervention. Results: Four RCTs with 669 children met our inclusion criteria. Intranasal dexmedetomidine substantially decreased the incidence of EA (RR = 0.39, 95% CI: 0.16 to 0.92, p = 0.03) and ED (RR = 0.45, 95% CI: 0.24 to 0.84, p = 0.01), despite significant heterogeneity. Pediatric Anesthesia Emergency Delirium (PAED) scores were also considerably lower in the dexmedetomidine group (MD = -2.11, 95% CI interval: -3.77 to -0.44, p = 0.01). We found significant changes in extubation time (p = 0.91) or PACU discharge time (p = 0.53). Conclusions: Intranasal dexmedetomidine may reduce the occurrence of EA and ED, while also lowering PAED scores in children undergoing tonsillectomy and/or adenoidectomy. And although it has demonstrated safety with few side effects, more research is needed to validate its impact on other perioperative outcomes and enhanced dosing regimens.

Keywords: adenoidectomy; children; dexmedetomidine; tonsillectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart of searching and screening processes.
Figure 2
Figure 2
Risk of bias assessment of the included studies using Rob-2 tool [11,20,21,22].
Figure 3
Figure 3
Incidence of Emergence Agitation and Delirium among patients taking dexmedetomidine and control groups [11,20,21].
Figure 4
Figure 4
(A) Pediatric Anesthesia Emergency Delirium (PAED) Scale (B) Time to Discharge from PACU (C) Extubation Time in Minutes among patients taking dexmedetomidine and control groups [11,20,21,22].
See this image and copyright information in PMC

References

    1. Watson A.T., Visram A. Children’s preoperative anxiety and postoperative behaviour. Paediatr. Anaesth. 2003;13:188–204. doi: 10.1046/j.1460-9592.2003.00848.x. - DOI - PubMed
    1. ZKain N., Mayes L.C., O’Connor T.Z., Cicchetti D.V. Preoperative anxiety in children: Predictors and outcomes. Arch. Pediatr. Adolesc. Med. 1996;150:1238–1245. - PubMed
    1. Kain Z.N., Mayes L.C., Caldwell-Andrews A.A., Karas D.E., McClain B.C. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118:651–658. doi: 10.1542/peds.2005-2920. - DOI - PubMed
    1. Mountain B.W., Smithson L., Cramolini M., Wyatt T.H., Newman M. Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium. AANA J. 2011;79:219–224. - PubMed
    1. Kuratani N., Oi Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: A meta-analysis of randomized controlled trials. Anesthesiology. 2008;109:225–232. doi: 10.1097/ALN.0b013e31817f5c18. - DOI - PubMed

LinkOut - more resources