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CLINICAL TRIAL article

Front. Pharmacol.
Sec. Obstetric and Pediatric Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1543344

Comparative evaluation of intravenous versus intranasal dexmedetomidine on emergence delirium and hemodynamics in pediatric patients undergoing adenotonsillectomy: a randomized controlled trial Authors

Provisionally accepted
Chenxu Dai Chenxu Dai 1,2Xuemei Zhao Xuemei Zhao 1,3Aoxue Li Aoxue Li 1Xuedong Zhang Xuedong Zhang 1Penglei Wang Penglei Wang 1Ye Zhang Ye Zhang 1Yun Wu Yun Wu 1*
  • 1 Second Affiliated Hospital of Anhui Medical University, Hefei, China
  • 2 Fuyang People’s Hospital, Fuyang, China
  • 3 Children’s Hospital of Anhui Province, Hefei, China

The final, formatted version of the article will be published soon.

    Background: Dexmedetomidine effectively prevents emergence delirium in children. However, intravenous dexmedetomidine is frequently associated with hemodynamic instability and delayed recovery. Intranasal dexmedetomidine has been proposed as a method of reducing these side effects. This study aimed to evaluate the effects of intranasal versus intravenous dexmedetomidine on emergence recovery and hemodynamics in children undergoing adenotonsillectomy.Methods: A total of 139 children, aged 3–10 years, who were scheduled for elective adenotonsillectomy were randomly assigned to receive intravenous dexmedetomidine (IV DEX group) or intranasal dexmedetomidine (IN DEX group), or saline (control group) after anesthesia induction. The primary outcome was the highest score on the pediatric anesthesia emergence delirium (PAED) score during the first 30 min after awakening. Secondary outcomes included the perioperative blood pressure and heart rate, time to awakening, postoperative pain score, and length of post-anesthesia care unit (PACU) stay.Results: The highest PAED and pain scores were significantly lower in the IV and IN DEX groups than in the control group during the first 30 min after awakening. However, no significant differences were observed between the IV and IN DEX groups. Notably, patients in the IN DEX group exhibited a significantly lower PAED score at 2 h and lower pain scores at 2, 4, and 6 h postoperatively than those in the IV DEX group. Patients in the IV DEX group exhibited a significantly longer awakening time and length of PACU stay than those in the IN DEX and control groups. In the IV DEX group, the heart rate was significantly lower perioperatively than at baseline, while this effect was not observed in the IN DEX group. Conclusion: Both intravenous and intranasal administration of dexmedetomidine after induction of anesthesia effectively improved emergence delirium and pain intensity in children undergoing adenotonsillectomy. Intranasal administration of dexmedetomidine provided more stable hemodynamics and more prolonged analgesia and sedation than intravenous infusion of dexmedetomidine.

    Keywords: Dexmedetomidine, emergence delirium, intravenous, intranasal, Hemodynamics, Recovery

    Received: 11 Dec 2024; Accepted: 14 Jan 2025.

    Copyright: © 2025 Dai, Zhao, Li, Zhang, Wang, Zhang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yun Wu, Second Affiliated Hospital of Anhui Medical University, Hefei, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.