{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:53:45Z","timestamp":1783551225457,"version":"3.55.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1038\/s41390-025-03851-2","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T15:51:48Z","timestamp":1741881108000},"page":"1266-1275","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of different intranasal dexmedetomidine doses on pediatric postoperative delirium and agitation: network meta-analysis"],"prefix":"10.1038","volume":"98","author":[{"given":"Huan","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liubo","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianqian","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianshu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"3851_CR1","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1007\/s00540-015-2098-5","volume":"30","author":"A Kanaya","year":"2016","unstructured":"Kanaya, A. Emergence agitation in children: Risk factors, prevention, and treatment. J. Anesth. 30, 261\u2013267 (2016).","journal-title":"J. Anesth."},{"key":"3851_CR2","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1046\/j.1460-9592.2002.00868.x","volume":"12","author":"JW Cole","year":"2002","unstructured":"Cole, J. W., Murray, D. J., McAllister, J. D. & Hirshberg, G. E. Emergence behaviour in children: Defining the incidence of excitement and agitation following anaesthesia. Paediatr. Anaesth. 12, 442\u2013447 (2002).","journal-title":"Paediatr. Anaesth."},{"key":"3851_CR3","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s40272-017-0212-x","volume":"19","author":"C Huett","year":"2017","unstructured":"Huett, C. et al. Prevention and therapy of pediatric emergence delirium: A national survey. Paediatr. drugs 19, 147\u2013153 (2017).","journal-title":"Paediatr. drugs"},{"key":"3851_CR4","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1111\/pan.12580","volume":"25","author":"M Somaini","year":"2015","unstructured":"Somaini, M. et al. Emergence delirium, pain or both? a challenge for clinicians. Paediatr. Anaesth. 25, 524\u2013529 (2015).","journal-title":"Paediatr. Anaesth."},{"key":"3851_CR5","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1093\/bja\/aew477","volume":"118","author":"KP Mason","year":"2017","unstructured":"Mason, K. P. Paediatric emergence delirium: A comprehensive review and interpretation of the literature. Br. J. Anaesth. 118, 335\u2013343 (2017).","journal-title":"Br. J. Anaesth."},{"key":"3851_CR6","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s00540-021-02946-4","volume":"35","author":"JY Kim","year":"2021","unstructured":"Kim, J. Y., Kim, K. N., Kim, D. W., Lim, H. J. & Lee, B. S. Effects of dexmedetomidine sedation for magnetic resonance imaging in children: A systematic review and meta-analysis. J. Anesth. 35, 525\u2013535 (2021).","journal-title":"J. Anesth."},{"key":"3851_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2020.109736","volume":"62","author":"Y Lin","year":"2020","unstructured":"Lin, Y. et al. Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials. J. Clin. Anesth. 62, 109736 (2020).","journal-title":"J. Clin. Anesth."},{"key":"3851_CR8","doi-asserted-by":"crossref","unstructured":"Poonai, N. et al. Intranasal dexmedetomidine for procedural distress in children: A systematic review. Pediatrics 145, e20191623 (2020).","DOI":"10.1542\/peds.2019-1623"},{"key":"3851_CR9","doi-asserted-by":"publisher","first-page":"e0169525","DOI":"10.1371\/journal.pone.0169525","volume":"12","author":"CR Barends","year":"2017","unstructured":"Barends, C. R., Absalom, A., van Minnen, B., Vissink, A. & Visser, A. Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety. PloS one 12, e0169525 (2017).","journal-title":"PloS one"},{"key":"3851_CR10","unstructured":"Miller, R. D., Eriksson, L., Fleisher, L. A., Wiener-Kronish, J. P. & Young, W. L. in Miller\u2019s Anesthesia 2827-2827 (2010)."},{"key":"3851_CR11","first-page":"l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne, J. A. C. et al. Rob 2: A revised tool for assessing risk of bias in randomised trials. BMJ (Clin. Res. ed.) 366, l4898 (2019).","journal-title":"BMJ (Clin. Res. ed.)"},{"key":"3851_CR12","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","volume":"343","author":"JP Higgins","year":"2011","unstructured":"Higgins, J. P. et al. The cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials. BMJ (Clin. Res. ed.) 343, d5928 (2011).","journal-title":"BMJ (Clin. Res. ed.)"},{"key":"3851_CR13","doi-asserted-by":"crossref","unstructured":"Abdelaziz, H. M. M., Bakr, R. H. & Kasem, A. A. Effect of intranasal dexmedetomidine or intranasal midazolam on prevention of emergence agitation in pediatric strabismus surgery: A randomized controlled study. J. Egyptian Journal of Anaesthesia. 32, 285\u2013291 (2016).","DOI":"10.1016\/j.egja.2015.11.009"},{"key":"3851_CR14","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.egja.2016.01.004","volume":"32","author":"WA Ali","year":"2016","unstructured":"Ali, W. A., Mohammed, A. K. & Elshorbagy, H. M. Dexmedetomidine Versus Ketofol effect on the incidence of emergence agitation associated with sevoflurane-based anesthesia in children undergoing orthopedic surgery. Egypt. J. Anaesth. 32, 277\u2013284 (2016).","journal-title":"Egypt. J. Anaesth."},{"key":"3851_CR15","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-019-0892-6","volume":"19","author":"Y Bi","year":"2019","unstructured":"Bi, Y., Ma, Y., Ni, J. & Wu, L. Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: A randomized, double-blind, placebo-controlled clinical trial. BMC Anesthesiol. 19, 219 (2019).","journal-title":"BMC Anesthesiol."},{"key":"3851_CR16","doi-asserted-by":"publisher","first-page":"137","DOI":"10.4103\/1658-354X.203020","volume":"11","author":"AMA El-Hamid","year":"2017","unstructured":"El-Hamid, A. M. A. & Yassin, H. M. Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and\/or adenoidectomy. Saudi J. Anaesth. 11, 137\u2013143 (2017).","journal-title":"Saudi J. Anaesth."},{"key":"3851_CR17","doi-asserted-by":"publisher","first-page":"e12140","DOI":"10.1097\/MD.0000000000012140","volume":"97","author":"LQ Li","year":"2018","unstructured":"Li, L. Q., Wang, C., Xu, H. Y., Lu, H. L. & Zhang, H. Z. Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy. Medicine 97, e12140 (2018).","journal-title":"Medicine"},{"key":"3851_CR18","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jclinane.2016.04.027","volume":"33","author":"Y Lin","year":"2016","unstructured":"Lin, Y. et al. Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane. J. Clin. Anesth. 33, 289\u2013295 (2016).","journal-title":"J. Clin. Anesth."},{"key":"3851_CR19","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1111\/j.1460-9592.2011.03615.x","volume":"21","author":"SR Pestieau","year":"2011","unstructured":"Pestieau, S. R. et al. The effect of dexmedetomidine during myringotomy and pressure-equalizing tube placement in children. Paediatr. Anaesth. 21, 1128\u20131135 (2011).","journal-title":"Paediatr. Anaesth."},{"key":"3851_CR20","doi-asserted-by":"publisher","first-page":"e2225473","DOI":"10.1001\/jamanetworkopen.2022.25473","volume":"5","author":"F Shen","year":"2022","unstructured":"Shen, F. et al. Effect of intranasal dexmedetomidine or midazolam for premedication on the occurrence of respiratory adverse events in children undergoing tonsillectomy and adenoidectomy: A randomized clinical trial. JAMA Netw. Open 5, e2225473 (2022).","journal-title":"JAMA Netw. Open"},{"key":"3851_CR21","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.1015357","volume":"13","author":"J Yao","year":"2022","unstructured":"Yao, J. et al. Parental presence and intranasal dexmedetomidine for the prevention of anxiety during anesthesia induction in children undergoing tonsillectomy and\/or adenoidectomy surgery: A randomized controlled trial. Front. Pharmacol. 13, 1015357 (2022).","journal-title":"Front. Pharmacol."},{"key":"3851_CR22","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/pan.12574","volume":"25","author":"Y Yao","year":"2015","unstructured":"Yao, Y. et al. Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: A prospective, randomized, double-blind, placebo-controlled trial. Paediatr. Anaesth. 25, 492\u2013498 (2015).","journal-title":"Paediatr. Anaesth."},{"key":"3851_CR23","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1097\/EJA.0000000000001270","volume":"37","author":"Y Yao","year":"2020","unstructured":"Yao, Y. et al. Intranasal dexmedetomidine versus oral midazolam premedication to prevent emergence delirium in children undergoing strabismus surgery: A randomised controlled trial. Eur. J. Anaesthesiol. 37, 1143\u20131149 (2020).","journal-title":"Eur. J. Anaesthesiol."},{"key":"3851_CR24","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/EJA.0000000000001097","volume":"37","author":"S Zhang","year":"2020","unstructured":"Zhang, S. et al. Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation: A randomised controlled trial. Eur. J. Anaesthesiol. 37, 85\u201390 (2020).","journal-title":"Eur. J. Anaesthesiol."},{"key":"3851_CR25","first-page":"6","volume":"22","author":"XL Yan","year":"2020","unstructured":"Yan, X. L., Y & Lin, N. The effect and safety of dexmedetomidine nasal pre-treatment on general anesthesia in children undergoing monocular fundus examination. Advers. Drug React. J. 22, 6 (2020).","journal-title":"Advers. Drug React. J."},{"key":"3851_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.754591","volume":"8","author":"L Chu","year":"2021","unstructured":"Chu, L. et al. Intranasal dexmedetomidine accompanied by cartoon video preoperation for reducing emergence delirium in children undergoing strabismus surgery: A prospective randomized trial. Front. Surg. 8, 754591 (2021).","journal-title":"Front. Surg."},{"key":"3851_CR27","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1097\/EJA.0000000000001743","volume":"39","author":"DX Lei","year":"2022","unstructured":"Lei, D. X. et al. Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anaesthesia: A prospective randomised trial. Eur. J. Anaesthesiol. 39, 858\u2013867 (2022).","journal-title":"Eur. J. Anaesthesiol."},{"key":"3851_CR28","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.jclinane.2008.04.008","volume":"20","author":"H Ayoglu","year":"2008","unstructured":"Ayoglu, H. et al. Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations. J. Clin. Anesth. 20, 437\u2013441 (2008).","journal-title":"J. Clin. Anesth."},{"key":"3851_CR29","doi-asserted-by":"publisher","first-page":"929","DOI":"10.21037\/tp-21-105","volume":"10","author":"X Zhang","year":"2021","unstructured":"Zhang, X. et al. Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: A meta-analysis of randomized controlled trials with sequential trial analysis. Transl. Pediatr. 10, 929\u2013957 (2021).","journal-title":"Transl. Pediatr."},{"key":"3851_CR30","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1097\/00000542-200405000-00015","volume":"100","author":"N Sikich","year":"2004","unstructured":"Sikich, N. & Lerman, J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology 100, 1138\u20131145 (2004).","journal-title":"Anesthesiology"},{"key":"3851_CR31","doi-asserted-by":"publisher","first-page":"2853","DOI":"10.2147\/DDDT.S207016","volume":"13","author":"J Zhang","year":"2019","unstructured":"Zhang, J. et al. Effects of peri-operative intravenous administration of dexmedetomidine on emergence agitation after general anesthesia in adults: A meta-analysis of randomized controlled trials. Drug Des. Dev. Ther. 13, 2853\u20132864 (2019).","journal-title":"Drug Des. Dev. Ther."},{"key":"3851_CR32","doi-asserted-by":"publisher","first-page":"e0240553","DOI":"10.1371\/journal.pone.0240553","volume":"15","author":"FW Chiang","year":"2020","unstructured":"Chiang, F. W. et al. Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis. PloS one 15, e0240553 (2020).","journal-title":"PloS one"},{"key":"3851_CR33","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.aat.2011.11.010","volume":"49","author":"S Bharati","year":"2011","unstructured":"Bharati, S., Pal, A., Biswas, C. & Biswas, R. Incidence of cardiac arrest increases with the indiscriminate use of dexmedetomidine: A case series and review of published case reports. Acta Anaesthesiol. Taiwanica 49, 165\u2013167 (2011).","journal-title":"Acta Anaesthesiol. Taiwanica"}],"container-title":["Pediatric Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-03851-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-03851-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-03851-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T07:49:07Z","timestamp":1761205747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41390-025-03851-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,13]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["3851"],"URL":"https:\/\/doi.org\/10.1038\/s41390-025-03851-2","relation":{},"ISSN":["0031-3998","1530-0447"],"issn-type":[{"value":"0031-3998","type":"print"},{"value":"1530-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,13]]},"assertion":[{"value":"9 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Based on former studies, all analyses did not involve ethical approval and patient consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}