Challenge of using Intranasal dexmedetomidine as a premedication modality in pediatric patients: A meta-analysis of randomized controlled trials

ABSTRACT Background Intranasal dexmedetomidine premedication has been employed in children for controlling stress before induction of general anesthesia. Until now, the effect of intranasal dexmedetomidine in relation to other premeditations remains incompletely studied. Objectives This study was conducted to study the effectiveness and safety of intranasal dexmedetomidine premedication in pediatrics. Sittings Meta-analysis-based study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methods Systematic searches of the databases MEDLINE, EMBASE, PubMed, and Cochrane were conducted to collect all published randomized, controlled, clinical trials in the last seven years which compare the intranasal dexmedetomidine premedication with other methods of premedication in different procedures. Results Twenty-five studies were collected for inclusion in this research including 2601 patients. The bias risk was low. Meta-analysis showed that the use of dexmedetomidine intranasally as a premedication when compared with other premedication regimes results in significant evidence of decreasing emergence agitation (RR = 0.64 [0.54, 0.77] 95% CI; I2 = 84%; P = 0.0001) fewer sedation scores (Mean difference = 51 [0.38, 0.65]; 95% CI; I2 = 99%; P = 0.00001), significantly less incidence of postoperative nausea and vomiting ((RR = 0.30 [0.20, 0.45] 95% CI; I2 = 12%; P = 0.00001), significantly decreased BP ((Mean difference = -2.28 [−3.42, −1.14]; 95% CI; I2 = 88%; P = 0.0001), and significantly decreased heart rate and (mean difference = -6.67 [−8.37, −4.97]; 95% CI; I2 = 94%; P = 0.00001). Conclusion Intranasal dexmedetomidine provided a satisfactory level of emergence agitation, more satisfactory sedation, more hemodynamic stability, and reduced the incidence of postoperative complications in relation to other premeditations.