{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:13:20Z","timestamp":1778523200226,"version":"3.51.4"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This prospective randomized clinical pilot study aimed to evaluate the effect of inhaled\u00a0Dexmedetomidine\u00a0in premedication in children after tonsillectomy with adenoidectomy on oxidative and inflammatory stress and the\u00a0drugs\u00a0impact on clinical parameters such as perioperative sedation, hemodynamics, respiratory function, postoperative delirium, analgesia, opioid consumption and frequency of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children aged 4\u201313 years with an indication for tonsillotomy with adenoidectomy were randomized into two groups: (D) \u2013\u00a0Dexmedetomidine\u00a0treated group and (N) \u2013 control,\u00a0non-treated\u00a0group.\u00a0Ramsey\u2019s\u00a0sedation score,\u00a0Bispectral\u00a0index (BIS), and vital signs (heart rate, respiratory rate, noninvasive blood pressure and hemoglobin oxygen saturation) were monitored perioperatively in at defined time points. After 15 minutes of extubation, the postoperative delirium score (PEAD) and pain score (VAS) were noticed. Pain scores were monitored for up to 12 postoperative hours every three hours on the ward. Venous blood samples were taken before intervention and after surgery to evaluate redox homeostasis (levels of malondialdehyde \u2013 MDA, nitrogen monoxide, glutathione and sulfhydryl groups and the activity of superoxide dismutase and catalase) and inflammatory parameters (blood count, neutrophile\/lymphocyte ratio, C-reactive protein and Interleukin 6). Perioperative complications in the induction phase, intraoperative and postoperative period, as well as the consumption of opioids, were noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>16 patients in the D and 15 in the N groups participated in the study. There was no difference in age, sex, body weight and duration of surgery between the two groups. The obtained results of oxidative stress and inflammatory response markers showed that there was a statistically significant difference in the MDA level between compared groups (postoperative MDA 88.93\u2009\u00b1\u20091.19 vs. 95.05\u2009\u00b1\u20091.58, \u0394MDA 0.014), with no difference observed in other investigated oxidative and inflammatory stress in plasma samples. Patients in both groups were hemodynamically and respiratory stable. Still, patients in the treated (D) group achieved the desired level of sedation compared to the control evaluated by the Ramsey sedation score (p\u2009&lt;\u20090.001). The BIS values were statistically significantly different between the D and N groups 30 minutes after inhalation (86.6\u2009\u00b1\u200911.6 vs. 98.1\u2009\u00b1\u20091.2, P\u2009&lt;\u20090.001), but showed no differences during and after the procedure. The two groups had a significant difference in pain control upon awakening and one hour after the operation, respectively (pain on awakening p\u2009=\u20090.024; pain during the first hour of stay in the ward p\u2009=\u20090.039). The consumption of intraoperative opioids was slightly lower in the D group than in the N group (D vs. N group: fentanyl in \u00b5g\/kg mean 3.67\u2009\u00b1\u20090.78 vs. 3.94\u2009\u00b1\u20091.12, p\u2009=\u20090.445, i.e., alfentanil in \u00b5g\/kg mean 2.02\u2009\u00b1\u20091.85 vs. 2.30\u2009\u00b1\u20092.08, p\u2009=\u20090.691). Also, there were no differences in observed perioperative complications between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inhaled\u00a0Dexmedetomidine\u00a0at a dose of 2 \u00b5g\/kg in premedication reduces oxidative stress. However, the statistical significance of this\u00a0drugs\u00a0effect on the level of markers of antioxidant defense and inflammation has not been proven in children operated on for tonsillar hypertrophy. This dose regimen and route of application of\u00a0Dexmedetomidine\u00a0significantly affect the degree of perioperative sedation and BIS values, provides perioperative hemodynamic and respiratory stability, significant immediate postoperative analgesia, and reduces the consumption of analgesics with minimal complications, which makes it useful for shorter surgical interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348763","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:37:39Z","timestamp":1778521059000},"page":"e0348763","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of nebulized dexmedetomidine for premedication on the parameters of oxidative and inflammatory stress in children undergoing tonsillotomy and adenoidectomy: A pilot randomized controlled trial"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-7544","authenticated-orcid":true,"given":"Vesna V.","family":"Stevanovic","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana D.","family":"Mandras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-9890","authenticated-orcid":true,"given":"Ana A.","family":"Djuric","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan A.","family":"Soldatovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragana V.","family":"Bojanin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6787-7964","authenticated-orcid":true,"given":"Branko Lj.","family":"Lukic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Predrag D.","family":"Stevanovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9714-1683","authenticated-orcid":true,"given":"Marija M.","family":"Stevic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandar M.","family":"Vlahovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"10","key":"pone.0348763.ref001","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.3390\/jcm13103017","article-title":"The Surgical Stress Response and Anesthesia: A Narrative Review","volume":"13","author":"R Ivascu","year":"2024","journal-title":"J Clin Med"},{"key":"pone.0348763.ref002","doi-asserted-by":"crossref","first-page":"8782387","DOI":"10.1155\/2021\/8782387","article-title":"Anesthesia-induced oxidative stress: are there differences between intravenous and inhaled anesthetics?","volume":"2021","author":"T Senoner","year":"2021","journal-title":"Oxid Med Cell Longev"},{"issue":"1","key":"pone.0348763.ref003","first-page":"1","article-title":"Pediatric perioperative stress responses and anesthesia","volume":"2","author":"K Yuki","year":"2017","journal-title":"Transl Perioper Pain Med"},{"issue":"1","key":"pone.0348763.ref004","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0261-5614(03)00097-9","article-title":"Oxidative stress in childhood--in health and disease states","volume":"23","author":"E Granot","year":"2004","journal-title":"Clin Nutr"},{"issue":"7","key":"pone.0348763.ref005","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.bjae.2020.02.006","article-title":"Anxiolytic premedication for children","volume":"20","author":"S Heikal","year":"2020","journal-title":"BJA Educ"},{"issue":"2","key":"pone.0348763.ref006","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.bja.2018.03.039","article-title":"Comparison of\u00a0nebulized\u00a0dexmedetomidine, ketamine, or midazolam for premedication in preschool children undergoing bone marrow biopsy","volume":"121","author":"HS Abdel-Ghaffar","year":"2018","journal-title":"Br J Anaesth"},{"key":"pone.0348763.ref007","doi-asserted-by":"crossref","DOI":"10.4103\/ija.ija_415_22","article-title":"Search for the ideal route of premedication in children far from over?","volume":"66","author":"S Sengupta","year":"2022","journal-title":"Indian J Anaesth"},{"key":"pone.0348763.ref008","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/978-3-031-26163-3_9","article-title":"Appraisal of the Neuroprotective Effect of Dexmedetomidine: A Meta-Analysis","volume":"1408","author":"S Gatica","year":"2023","journal-title":"Adv Exp Med Biol"},{"issue":"6","key":"pone.0348763.ref009","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1053\/j.jvca.2023.02.013","article-title":"Effects of Dexmedetomidine on Brain and Inflammatory Outcomes In Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"37","author":"M Hashiya","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"5","key":"pone.0348763.ref010","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/pan.13370","article-title":"Consensus statement on clear fluids fasting for elective pediatric general anesthesia","volume":"28","author":"M Thomas","year":"2018","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"pone.0348763.ref011","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/j.1471-4159.1989.tb07375.x","article-title":"Ischemic modification of cerebrocortical membranes: 5-hydroxytryptamine receptors, fluidity, and inducible in vitro lipid peroxidation","volume":"53","author":"A Villacara","year":"1989","journal-title":"J Neurochem"},{"issue":"1","key":"pone.0348763.ref012","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00005373-199101000-00007","article-title":"Early measurement of systemic lipid peroxidation products in the plasma of major blunt trauma patients","volume":"31","author":"MJ Girotti","year":"1991","journal-title":"J Trauma"},{"issue":"3","key":"pone.0348763.ref013","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1093\/clinchem\/44.3.679","article-title":"Semiautomated measurement of nitrate in biological fluids","volume":"44","author":"JA Navarro-Gonz\u00e1lvez","year":"1998","journal-title":"Clin Chem"},{"key":"pone.0348763.ref014","first-page":"317","article-title":"The DTNB-GSSG reductase recycling assay for total glutathione (GSH 1\/2GSSG).","volume-title":"Tissue glutathione","author":"ME. Anderson","year":"1996"},{"issue":"1","key":"pone.0348763.ref015","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/0003-2697(78)90010-6","article-title":"An improved spectrophotometric assay for superoxide dismutase based on epinephrine autoxidation","volume":"90","author":"M Sun","year":"1978","journal-title":"Anal Biochem"},{"issue":"4","key":"pone.0348763.ref016","first-page":"185","article-title":"Rapid kinetic microassay for catalase activity","volume":"18","author":"Y Li","year":"2007","journal-title":"J Biomol Tech"},{"issue":"1","key":"pone.0348763.ref017","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/0003-9861(59)90090-6","article-title":"Tissue sulfhydryl groups","volume":"82","author":"GL ELLMAN","year":"1959","journal-title":"Arch Biochem Biophys"},{"issue":"4","key":"pone.0348763.ref018","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/pst.185","article-title":"Sample size of 12 per group rule of thumb for a pilot study","volume":"4","author":"SA Julious","year":"2005","journal-title":"Pharm Stat"},{"issue":"6","key":"pone.0348763.ref019","doi-asserted-by":"crossref","first-page":"601","DOI":"10.4097\/kjae.2017.70.6.601","article-title":"Introduction of a pilot study","volume":"70","author":"J In","year":"2017","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"pone.0348763.ref020","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s00228-020-03028-2","article-title":"Off-label use of\u00a0Dexmedetomidine\u00a0in paediatric anaesthesiology: an international survey of 791 (paediatric) anaesthesiologists","volume":"77","author":"CE van Hoorn","year":"2021","journal-title":"Eur J Clin Pharmacol"},{"issue":"9","key":"pone.0348763.ref021","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1111\/bcp.13293","article-title":"A multinational, drug utilization study to investigate the use of dexmedetomidine (Dexdor\u00ae) in clinical practice in the EU","volume":"83","author":"M Weatherall","year":"2017","journal-title":"Br J Clin Pharmacol"},{"issue":"8","key":"pone.0348763.ref022","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.redar.2021.03.013","article-title":"Dexmedetomidine and perioperative analgesia in children","volume":"69","author":"R Eizaga Rebollar","year":"2022","journal-title":"Rev Esp Anestesiol Reanim (Engl Ed)"},{"issue":"1","key":"pone.0348763.ref023","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1213\/ANE.0000000000000728","article-title":"A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery","volume":"121","author":"OM Zanaty","year":"2015","journal-title":"Anesth Analg"},{"issue":"2","key":"pone.0348763.ref024","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1093\/bja\/aev226","article-title":"Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations","volume":"115","author":"M Mahmoud","year":"2015","journal-title":"Br J Anaesth"},{"issue":"3","key":"pone.0348763.ref025","first-page":"330","article-title":"Nebulized dexmedetomidine alleviates oxidative stress in ventilator-induced lung injury via Keap1-Nrf2-ARE pathway","volume":"23","author":"J Zha","year":"2024","journal-title":"Iran J Allergy Asthma Immunol"},{"issue":"1","key":"pone.0348763.ref026","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3892\/mmr.2022.12889","article-title":"Dexmedetomidine attenuates airway inflammation and oxidative stress in asthma via the Nrf2 signaling pathway","volume":"27","author":"S Xiao","year":"2023","journal-title":"Mol Med Rep"},{"issue":"10","key":"pone.0348763.ref027","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.bjae.2020.05.004","article-title":"Dexmedetomidine in paediatric anaesthesia","volume":"20","author":"R Lin","year":"2020","journal-title":"BJA Educ"},{"issue":"3","key":"pone.0348763.ref028","first-page":"330","article-title":"Nebulized dexmedetomidine alleviates oxidative stress in ventilator-induced lung injury via keap1-nrf2-are pathway","volume":"23","author":"J Zha","year":"2024","journal-title":"Iran J Allergy Asthma Immunol"},{"key":"pone.0348763.ref029","first-page":"358396","article-title":"Dexmedetomidine attenuates oxidative stress induced lung alveolar epithelial cell apoptosis in vitro","volume":"2015","author":"J Cui","year":"2015","journal-title":"Oxid Med Cell Longev"},{"issue":"4","key":"pone.0348763.ref030","doi-asserted-by":"crossref","first-page":"787","DOI":"10.3390\/antiox11040787","article-title":"Neonatal Anesthesia and Oxidative Stress","volume":"11","author":"DA Gascoigne","year":"2022","journal-title":"Antioxidants"},{"issue":"5","key":"pone.0348763.ref031","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000539528","article-title":"Donor Inhalation of Nebulized Dexmedetomidine Alleviates Ischemia-Reperfusion Injury in Rat Lung Transplantation","volume":"109","author":"J Wang","year":"2024","journal-title":"Pharmacology"},{"issue":"4","key":"pone.0348763.ref032","doi-asserted-by":"crossref","DOI":"10.5812\/ans.118182","article-title":"Assessing the antioxidant activity of dexmedetomidine by measuring the plasma antioxidant enzyme activity of catalase, gluthation peroxidase, and superoxide dimutase during lumbar spine laminectomy","volume":"8","author":"K Mottaghi","year":"2021","journal-title":"Arch Neurosci"},{"issue":"1","key":"pone.0348763.ref033","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13054-017-1645-x","article-title":"Anti-inflammatory properties of anesthetic agents","volume":"21","author":"FF Cruz","year":"2017","journal-title":"Crit Care"},{"issue":"6","key":"pone.0348763.ref034","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.bja.2019.07.027","article-title":"Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis","volume":"123","author":"K Wang","year":"2019","journal-title":"Br J Anaesth"},{"issue":"1","key":"pone.0348763.ref035","article-title":"Effect of dexmedetomidine infusion on hemodynamics and stress responses in pediatric cardiac surgery: a randomized trial","volume":"6","author":"Z Totonchi","year":"2017","journal-title":"Res Cardiovasc Med"},{"issue":"6","key":"pone.0348763.ref036","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1053\/j.jvca.2023.02.013","article-title":"Effects of Dexmedetomidine on Brain and Inflammatory Outcomes In Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"37","author":"M Hashiya","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"10","key":"pone.0348763.ref037","doi-asserted-by":"crossref","first-page":"5075","DOI":"10.1097\/MS9.0000000000001170","article-title":"Dexmedetomidine as a myocardial protector in pediatric heart surgery using cardiopulmonary bypass: a systematic review","volume":"85","author":"D Kesumarini","year":"2023","journal-title":"Ann Med Surg (Lond)"},{"issue":"7","key":"pone.0348763.ref038","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1111\/pan.14189","article-title":"The effect of dexmedetomidine premedication on postoperative systemic inflammatory response in children undergoing hernia repair surgery: A randomized controlled trial","volume":"31","author":"Z Du","year":"2021","journal-title":"Paediatr Anaesth"},{"issue":"7","key":"pone.0348763.ref039","doi-asserted-by":"crossref","first-page":"846","DOI":"10.3390\/brainsci11070846","article-title":"The Current Role of Dexmedetomidine as Neuroprotective Agent: An Updated Review","volume":"11","author":"Z Liaquat","year":"2021","journal-title":"Brain Sci"},{"issue":"2","key":"pone.0348763.ref040","doi-asserted-by":"crossref","first-page":"173","DOI":"10.17085\/apm.21081","article-title":"Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial","volume":"17","author":"G Singariya","year":"2022","journal-title":"Anesth Pain Med (Seoul)"},{"issue":"5","key":"pone.0348763.ref041","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/pan.14857","article-title":"A randomized, double-blind, dose-controlled study of the use of dexmedetomidine alone for procedural sedation of children and adolescents undergoing MRI scans","volume":"34","author":"U Khan","year":"2024","journal-title":"Paediatr Anaesth"},{"issue":"11","key":"pone.0348763.ref042","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1111\/pan.14740","article-title":"Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine","volume":"33","author":"\u00c5 Bromfalk","year":"2023","journal-title":"Paediatr Anaesth"},{"key":"pone.0348763.ref043","doi-asserted-by":"crossref","first-page":"109736","DOI":"10.1016\/j.jclinane.2020.109736","article-title":"Dexmedetomidine versus other sedatives for non-painful pediatric examinations: A systematic review and meta-analysis of randomized controlled trials","volume":"62","author":"Y Lin","year":"2020","journal-title":"J Clin Anesth"},{"key":"pone.0348763.ref044","doi-asserted-by":"crossref","first-page":"865107","DOI":"10.3389\/fped.2022.865107","article-title":"The Sedative Effects of Inhaled Nebulized Dexmedetomidine on Children: A Systematic Review and Meta-Analysis","volume":"10","author":"J Lin","year":"2022","journal-title":"Front Pediatr"},{"issue":"120","key":"pone.0348763.ref045","doi-asserted-by":"crossref","first-page":"14","DOI":"10.30699\/jambs.27.120.14","article-title":"Comparing the Hemodynamic Effects of Nebulized Dexmedetomidine and Nebulized Lidocaine in Children undergoing Fiberoptic Bronchoscopy","volume":"27","author":"A Shafa","year":"2019","journal-title":"J Adv Med Biomed Res"},{"issue":"1","key":"pone.0348763.ref046","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12871-025-02946-x","article-title":"Effect of preoperative dexmedetomidine administration on the bispectral index in children during sevoflurane inhalation anesthesia: a randomized controlled trial","volume":"25","author":"Z Xiang","year":"2025","journal-title":"BMC Anesthesiol"},{"issue":"10","key":"pone.0348763.ref047","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.bjae.2020.05.004","article-title":"Dexmedetomidine in paediatric anaesthesia","volume":"20","author":"R Lin","year":"2020","journal-title":"BJA Educ"},{"issue":"2","key":"pone.0348763.ref048","article-title":"Nebulized versus intravenously administered dexmedetomidine for obtunding hemodynamic responses to laryngoscopy and tracheal intubation: a randomized double-blind comparative study","volume":"16","author":"A Singla","year":"2024","journal-title":"Cureus"},{"issue":"5","key":"pone.0348763.ref049","article-title":"Evaluation of\u00a0nebulized\u00a0dexmedetomidine given pre-operatively to attenuate hemodynamic response to laryngoscopy and endotracheal intubation: a\u00a0randomized\u00a0control trial","volume":"14","author":"P Shrivastava","year":"2022","journal-title":"Cureus"},{"issue":"1","key":"pone.0348763.ref050","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1080\/11101849.2022.2079901","article-title":"The effect of nebulized dexmedetomidine as sedative premedication in pediatrics undergoing cochlear implantation","volume":"38","author":"RM Ali","year":"2022","journal-title":"Egyptian Journal of Anaesthesia"},{"issue":"6","key":"pone.0348763.ref051","article-title":"Nebulized\u00a0dexmedetomidine versus\u00a0nebulized\u00a0lignocaine in blunting the\u00a0hemodynamic\u00a0response to laryngoscopy and endotracheal intubation: a randomised control study","volume":"18","author":"A Rani","year":"2024","journal-title":"J Clin of Diagn Res"},{"key":"pone.0348763.ref052","article-title":"Effectiveness of dexmedetomidine as a premedication for pediatric patients undergoing outpatient dental surgery under general anaesthesia-systematic review and meta-analysis","volume":"13","author":"X Zhang","year":"2025","journal-title":"PeerJ"},{"issue":"6","key":"pone.0348763.ref053","first-page":"948","article-title":"The Effects of Dexmedetomidine on Children Undergoing Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis","volume":"10","author":"V-A Angelopoulou","year":"2023","journal-title":"Children (Basel)"},{"issue":"6","key":"pone.0348763.ref054","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3892\/etm.2023.11985","article-title":"Effect of dexmedetomidine on preventing perioperative respiratory adverse events in children: A systematic review and meta\u2011analysis of randomized controlled trials","volume":"25","author":"J Zhang","year":"2023","journal-title":"Exp Ther Med"},{"issue":"8","key":"pone.0348763.ref055","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.25473","article-title":"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","volume":"5","author":"F Shen","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pone.0348763.ref056","first-page":"63","article-title":"The effect of two different doses of dexmedetomidine to prevent emergence agitation in children undergoing adenotonsillectomy: a randomized controlled trial","volume":"72","author":"W Yi","year":"2022","journal-title":"Braz J Anesthesiol"},{"issue":"8","key":"pone.0348763.ref057","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/pan.14689","article-title":"The effect of intranasal dexmedetomidine administration on emergence agitation or delirium in pediatric patients after general anesthesia: A meta-analysis of randomized controlled trials","volume":"33","author":"H-S Na","year":"2023","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"pone.0348763.ref058","doi-asserted-by":"crossref","first-page":"367","DOI":"10.37899\/journallamedihealtico.v6i2.1965","article-title":"Nebulized Dexmedetomidine to Reduce Delirium after General Anesthesia Sevoflurane Inhalation in Preschool Children Undergoing Elective Surgery","volume":"6","author":"J Wongkar","year":"2025","journal-title":"JLMH"},{"key":"pone.0348763.ref059","doi-asserted-by":"crossref","first-page":"580226","DOI":"10.3389\/fped.2020.580226","article-title":"Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials","volume":"8","author":"X Yang","year":"2020","journal-title":"Front Pediatr"},{"issue":"4","key":"pone.0348763.ref060","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s12070-025-05415-6","article-title":"Nebulized Dexmedetomidine for Postoperative Sore Throat: A Systematic Review and Meta-analysis","volume":"77","author":"S Puri","year":"2025","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"issue":"2","key":"pone.0348763.ref061","doi-asserted-by":"crossref","first-page":"104","DOI":"10.4103\/1658-354X.97019","article-title":"Dexmedetomidine: A look at a promising new avenue of use","volume":"6","author":"TM Halaszynski","year":"2012","journal-title":"Saudi J Anaesth"},{"issue":"1","key":"pone.0348763.ref062","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1186\/s12887-024-04832-w","article-title":"Effects of different doses of intranasal dexmedetomidine on related complications and parents\u2019 satisfaction in anesthetized children: a systematic review","volume":"24","author":"W Hu","year":"2024","journal-title":"BMC Pediatr"},{"issue":"1","key":"pone.0348763.ref063","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1213\/01.ANE.0000093225.39866.75","article-title":"The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery","volume":"98","author":"SR Arain","year":"2004","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0348763.ref064","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1186\/s12871-025-03106-x","article-title":"Effect of nebulized dexmedetomidine on gag reflex suppression and sedation quality in pediatric patients undergoing gastrointestinal endoscopy: a randomized controlled trial","volume":"25","author":"E Turunc","year":"2025","journal-title":"BMC Anesthesiol"},{"issue":"9","key":"pone.0348763.ref065","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/j.1365-2044.2010.06453.x","article-title":"Optimal timing for the administration of intranasal dexmedetomidine for premedication in children","volume":"65","author":"VM Yuen","year":"2010","journal-title":"Anaesthesia"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348763","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:37:48Z","timestamp":1778521068000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348763"}},"subtitle":[],"editor":[{"given":"Benjamin","family":"Benzon","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":65,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348763","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}