Effect of different intranasal dexmedetomidine doses on pediatric postoperative delirium and agitation: network meta-analysis

Abstract

Our research served to explore the influences of intranasal dexmedetomidine (DEX) at different doses on agitation, delirium, and other complications among children undergoing general anesthesia. A systematic search was executed in EMBASE, Cochrane Library, PubMed, and Web of Science, from the establishment of the database until February 12, 2024. The data analytics was implemented through R software and STATA version 16.0. The final analysis incorporated 15 randomized controlled trials (RCTs) containing 1965 pediatric participants in total. The findings uncovered that relative to normal saline (NS), intranasal DEX at doses of 1 μg/kg [RR = 0.31, 95%CI = (0.17, 0.56)], 1.5 μg/kg [RR = 0.28, 95%CI = (0.09, 0.85)], and 2 μg/kg [RR = 0.18, 95%CI = (0.08, 0.36)] remarkably reduced the prevalence of post-anesthetic emergence agitation (EA) in children, with the 2 μg/kg dose demonstrating the highest effectiveness (SUCRA = 0.8997). Additionally, DEX at doses of 1 μg/kg [MD = −3.36, 95%CI = (−6.46, −0.44)] and 2 μg/kg [MD = −2.59, 95%CI = (−5.17, −0.32)] effectively reduced the Pediatric Anesthesia Emergence Delirium (PAED) score, with the 1 μg/kg dose ranking as the most efficacious according to SUCRA analysis (SUCRA = 0.8557). DEX prominently reduces the prevalence of emergence agitation and delirium. At doses of 2 μg/kg and 1 μg/kg, DEX effectively lowers the incidence of EA and PAED scores.