Intranasal Dexmedetomidine Compared With Intranasal Midazolam for Pediatric Emergence Delirium: A Systematic Review and Meta-analysis.

Purpose: Evaluate the effectiveness of intranasal dexmedetomidine compared with intranasal midazolam in reducing pediatric emergence delirium (ED).

Design: Systematic review and meta-analysis.

Methods: A comprehensive search was conducted in MEDLINE (PubMed), CINAHL, the Cochrane Review Database, Google Scholar, and gray literature to identify relevant studies. Risk ratios (RR) and standardized mean differences were calculated to estimate the outcomes, using appropriate effect models. The quality of evidence was assessed using the Risk of Bias tool and evaluated according to the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Findings: Twelve studies (N = 1,133) were included in the review. Intranasal dexmedetomidine significantly reduced the incidence of ED (RR 0.52, 95% confidence interval [CI], 0.29 to 0.90, P = .02) compared with midazolam. Intranasal dexmedetomidine also demonstrated significantly improved sedation levels (standardized mean differences -0.48, 95% CI, -0.92 to -0.04, P = .03) compared with midazolam. However, no significant differences were observed in parental separation (RR 1.14, 95% CI, 0.94 to 1.39, P = .19), mask acceptance (RR 1.05, 95% CI, 0.83 to 1.34, P = .67), or postoperative nausea and vomiting (RR 0.84, 95% CI, 0.44 to 1.61, P = .61). The overall quality of evidence was rated as low, primarily due to the small number of studies included.

Conclusions: Intranasal dexmedetomidine significantly reduces pediatric ED and improves sedation levels compared with midazolam, but both drugs show similar effects on parental separation, mask acceptance, and postoperative nausea and vomiting. Intranasal administration offers a noninvasive, effective option for pediatric sedation. Larger studies are needed to confirm these findings, as current evidence is limited.