{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:04:25Z","timestamp":1789103065787,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Princess Nourah bint Abdulrahman University","award":["PNURSP2025R390"],"award-info":[{"award-number":["PNURSP2025R390"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u20132 \u00b5g\/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 = \u22122.11, 95% CI interval: \u22123.77 to \u22120.44, 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.<\/jats:p>","DOI":"10.3390\/jcm14051586","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T11:22:12Z","timestamp":1740568932000},"page":"1586","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A Meta-Analysis of the Impact of Intranasal Dexmedetomidine on Emergence Delirium and Agitation in Children and Adolescents Undergoing Tonsillectomy and\/or Adenoidectomy"],"prefix":"10.3390","volume":"14","author":[{"given":"Abbas","family":"Al Mutair","sequence":"first","affiliation":[{"name":"Department of Medical-Surgical Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5814-9690","authenticated-orcid":false,"given":"Yasmine","family":"Alabbasi","sequence":"additional","affiliation":[{"name":"Department of Maternity and Pediatric Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9631-8870","authenticated-orcid":false,"given":"Bushra","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1157-8185","authenticated-orcid":false,"given":"Awatif M.","family":"Alrasheeday","sequence":"additional","affiliation":[{"name":"Nursing Administration Department, College of Nursing, University of Hail, Hail 21424, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2500-6700","authenticated-orcid":false,"given":"Hanan F.","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Department of Maternity and Pediatric Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulsalam M.","family":"Aleid","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical College, King Faisal University, Hofuf 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1046\/j.1460-9592.2003.00848.x","article-title":"Children\u2019s preoperative anxiety and postoperative behaviour","volume":"13","author":"Watson","year":"2003","journal-title":"Paediatr. Anaesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1001\/archpedi.1996.02170370016002","article-title":"Preoperative anxiety in children: Predictors and outcomes","volume":"150","author":"ZKain","year":"1996","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1542\/peds.2005-2920","article-title":"Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery","volume":"118","author":"Kain","year":"2006","journal-title":"Pediatrics"},{"key":"ref_4","first-page":"219","article-title":"Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium","volume":"79","author":"Mountain","year":"2011","journal-title":"AANA J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/ALN.0b013e31817f5c18","article-title":"Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: A meta-analysis of randomized controlled trials","volume":"109","author":"Kuratani","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Xiao, Y., Jin, X., Zhang, Y., Huang, T., Zhou, L., and Gao, J. (2022). Efficacy of propofol for the prevention of emergence agitation after sevoflurane anaesthesia in children: A meta-analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1031010"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/pan.12815","article-title":"\u03bc-Opioid agonists for preventing emergence agitation under sevoflurane anesthesia in children: A meta-analysis of randomized controlled trials","volume":"26","author":"Tan","year":"2016","journal-title":"Pediatr. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"111361","DOI":"10.1016\/j.jclinane.2023.111361","article-title":"Anaesthetic management of paediatric patients undergoing electrophysiology study and ablation for supraventricular tachycardia: A focused narrative review","volume":"93","author":"Monaco","year":"2024","journal-title":"J. Clin. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/EJA.0000000000001936","article-title":"Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery: A randomized controlled trial","volume":"41","author":"Hebbar","year":"2024","journal-title":"Eur. J. Anaesthesiol. EJA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3559","DOI":"10.2147\/DDDT.S269765","article-title":"Ketamine enhances intranasal dexmedetomidine-induced sedation in children: A randomized, double-blind trial","volume":"14","author":"Qian","year":"2020","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Shen, F., Zhang, Q., Xu, Y., Wang, X., Xia, J., Chen, C., Liu, H., and Zhang, Y. (2022). 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.","DOI":"10.1001\/jamanetworkopen.2022.25473"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4693","DOI":"10.2147\/DDDT.S488706","article-title":"Intranasal Dexmedetomidine-Esketamine Combination Premedication versus Monotherapy for Reducing Emergence Delirium and Postoperative Behavioral Changes in Pediatric Tonsillectomy and\/or Adenoidectomy: A Randomized Controlled Trial","volume":"18","author":"Liao","year":"2024","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.4103\/joacp.JOACP_51_18","article-title":"Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings","volume":"35","author":"Kaye","year":"2019","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/ACO.0000000000000488","article-title":"Dexmedetomidine: The new all-in-one drug in paediatric anaesthesia?","volume":"30","author":"Sottas","year":"2017","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_15","first-page":"170","article-title":"Intranasal dexmedetomidine for sedation in children; a review","volume":"30","author":"Lewis","year":"2020","journal-title":"J. Perioper. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Aki, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med., 18.","DOI":"10.31222\/osf.io\/v7gm2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/jrsm.1411","article-title":"Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2021","journal-title":"Res. Synth. Methods"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s13643-019-1070-0","article-title":"Introducing RAPTOR: RevMan Parsing Tool for Reviewers","volume":"8","author":"Schmidt","year":"2019","journal-title":"Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/1658-354X.203020","article-title":"Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and\/or adenoidectomy","volume":"11","author":"Yassin","year":"2017","journal-title":"Saudi J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Li, L.-Q., Wang, C., Xu, H.-Y., Lu, H.-L., and Zhang, H.-Z. (2018). 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.","DOI":"10.1097\/MD.0000000000012140"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yao, J., Gong, H., Zhao, X., Peng, Q., Zhao, H., and Yu, S. (2022). 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.","DOI":"10.3389\/fphar.2022.1015357"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1111\/j.1460-9592.2012.03802.x","article-title":"Dexmedetomidine vs midazolam for premedication of pediatric patients undergoing anesthesia","volume":"22","author":"Akin","year":"2012","journal-title":"Pediatr. Anesth."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hu, W., Wang, M., and Sun, F. (2024). Effects of different doses of intranasal dexmedetomidine on related complications and parents\u2019 satisfaction in anesthetized children: A systematic review. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-04832-w"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1007\/s12035-020-02223-7","article-title":"Neuroprotective effects against cerebral ischemic Injury exerted by Dexmedetomidine via the HDAC5\/NPAS4\/MDM2\/PSD-95 Axis","volume":"58","author":"Lv","year":"2021","journal-title":"Mol. Neurobiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s40262-017-0507-7","article-title":"Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine","volume":"56","author":"Weerink","year":"2017","journal-title":"Clin. Pharmacokinet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1111\/aas.12715","article-title":"Usability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities","volume":"60","author":"Najafi","year":"2016","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/pan.12284","article-title":"The sedative effects and the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation in pediatric patients: A randomized comparison between two different doses of preoperative intranasal dexmedetomidine","volume":"24","author":"Wang","year":"2014","journal-title":"Pediatr. Anesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/pan.12287","article-title":"Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: A double-blinded randomized controlled trial","volume":"24","author":"Sheta","year":"2014","journal-title":"Pediatr. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jclinane.2009.01.019","article-title":"The frequency of fentanyl-induced cough in children and its effects on tracheal intubation","volume":"22","author":"Han","year":"2010","journal-title":"J. Clin. Anesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00540-024-03358-w","article-title":"on behalf of Collaborators. Remimazolam for anesthesia and sedation in pediatric patients: A scoping review","volume":"38","author":"Pieri","year":"2024","journal-title":"J. Anesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.bja.2023.08.019","article-title":"Pharmacokinetics of remimazolam after intravenous infusion in anaesthetised children","volume":"131","author":"Gao","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1515\/med-2022-0509","article-title":"Advantages of ketamine in pediatric anesthesia","volume":"17","author":"Simonini","year":"2022","journal-title":"Open Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1016\/j.jopan.2024.01.019","article-title":"The Effect of Different Propofol-Ketamine Combinations on Emergence Delirium in Children Undergoing Adenoidectomy and Tonsillectomy Surgery","volume":"39","author":"Biricik","year":"2024","journal-title":"J. PeriAnesthesia Nurs."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1586\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:22Z","timestamp":1760028202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1586"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051586"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051586","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]}}}