Efficacy of dexmedetomidine in preventing emergence agitation in children undergoing tonsillectomy and/or adenoidectomy: a meta-analysis and systematic review

Emergence agitation (EA) affects 10–80% of children after general anesthesia, with high rates following tonsillectomy and/or adenoidectomy. Although dexmedetomidine shows potential for preventing EA, its efficacy and safety in this specific pediatric population remain uncertain, with conflicting evidence from previous studies. Computerized searches of PubMed, The Cochrane Library, Web of Science, Embase, and OpenGrey were performed, and the search timeframe was from the time of construction to September 26, 2024, for all searches. Literature screening, data extraction, and evaluation of the risk of bias of the included studies were performed independently by two investigators. A meta-analysis was performed using STAT14 software, and heterogeneity was examined through subgroup analysis and meta-regression for route of administration, control medications, general anesthesia procedures, and EA assessment methods. The certainty of results was checked using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Our study comprised 19 studies with 1697 children. Dexmedetomidine significantly reduced the incidence of EA in thirteen studies of 1222 children (RR = 0.36, 95% CI [0.30, 0.45], P = 0.036, I2 = 45.7%, GRADE = high). Subgroup analyses and meta-regression showed that different scales were the source of heterogeneity in EA incidence outcomes and that dexmedetomidine was more potent than other medications in reducing EA incidence (RR = 0.45, 95% CI [0.33, 0.61], P = 0.302). In eight studies, dexmedetomidine significantly decreased EA scores (SMD = − 0.77, 95% CI [− 1.08, − 0.47], P < 0.001, I2 = 77.6%, GRADE = moderate). Dexmedetomidine was superior to other medications in reducing EA scores (SMD = − 0.51, 95% CI [− 0.78, − 0.23], P = 0.052). Dexmedetomidine reduces pain scores (SMD = − 1.08, 95% CI [− 1.66, − 0.51], P < 0.001), postoperative nausea and vomiting (PONV)(RR = 0.51, 95% CI [0.38, 0.69], P = 0.900), respiratory adverse events (desaturation: RR = 0.41, 95% CI [0.32, 0.53], P = 0.578; cough: RR = 0.27, 95% CI [0.14, 0.52], P = 0.56; laryngospasm or bronchospasm: RR = 0.25, 95% CI [0.09, 0.73], P = 0.773). No significant variations in post-anesthesia care unit and extubation time. Perioperative dexmedetomidine in children undergoing tonsillectomy and/or adenoidectomy reduces EA, pain, PONV, and respiratory adverse events without significant side effects. CRD42024506421.