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

<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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, <i>p</i> = 0.03) and ED (RR = 0.45, 95% CI: 0.24 to 0.84, <i>p</i> = 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, <i>p</i> = 0.01). We found significant changes in extubation time (<i>p</i> = 0.91) or PACU discharge time (<i>p</i> = 0.53). <b>Conclusions:</b> 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.