The effect of different dosage of intranasal dexmedetomidine on preventing emergence delirium or agitation in children: A network meta-analysis of randomized controlled trials

Background: The clinical evidence for the effects of different doses of intranasal dexmedetomidine on emergence delirium/ emergence agitation (ED/EA) in children is lacking. Methods: We searched the PubMed, EMBASE and Cochrane Library from the establishment of the databases until December 30, 2023. All randomized controlled trials that evaluated the effect of different dosage of intranasl dexamedetomidine in children younger than 18 years on postoperative ED/ EA were included. Data analysis was conducted using R 4.3.0. Results: A total of 15 randomized controlled trials involving 1566 children were included. Compared to 0.5 μg/kg (RR = 4.81, 95%CI = 1.66–13.94), and normal saline (RR = 8.23, 95%CI = 4.63–14.65), intranasal dexmedetomidine at doses of 2 μg/kg significantly reduced the incidence of ED/ EA in children. 2 μg/kg was the most effective dosage in reducing the incidence of ED/ EA (Probability of rank = 0.75), the incidence of severe ED/ EA (Probability of rank = 0.45), and ED/ EA score (Probability of rank = 0.65). Moreover, intranasal dexmedetomidine at doses of 2 μg/kg significantly reduced the PACU pain compared to 0.5 μg/kg (RR = 0.42, 95%CI = -0.22–1.06), 1 μg/kg (RR = 0.18, 95%CI = -0.26–0.63), 1.5 μg/kg (RR = 1.00, 95%CI = -0.54–0.75), and normal saline (RR = 8.23, 95%CI = 4.63–14.65), with a probability of rank = 0.45. Conclusion: 2μg/kg intranasal dexmedetomidine is the optimum dose for reducing the occurrence of ED/ EA and postoperative pain. However, further research is required to verify our findings.