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

Figures & data

Figure 1. (PRISMA) flow chart representing the search and selection process.

Table 1. Characteristics of included studies.

Study ID	Intervention	Dose	Nm.	Age	Timing of injection	Surgery
Singla et al. 2015 [21]	IN DEX.	1 mcg/kg	30	5.86 ± 0.4 yrs.	30 min. before induction	Minor surgery
	IN midazolam	0.2 mg/kg	30	5.9 ± 0.46 yrs.
Mukherjee et al. 2015 [22]	IN DEX.	1 mcg/kg	40	5.3 ± 1.8 yrs.	45 min. before induction	Day case surgery
	IN Clonidine	4 mcg/kg	40	5.6 ± 1.9 yrs.
Rajalakshmi et al. 2015 [23]	IN DEX.	2 mcg/kg	30	4.83 ± 2.12 yrs.	In the holdingare23,29,32,33,37,39,41,43,44,45)a	Cardiac surgeries
	IN Saline	1 ml	30	5.17 ± 1.89 yrs.
Millar et al. 2016 [24]	Oral chloral hydrate	70 mg/kg	50	13.6 ± 7.6 mon	Before the procedure	Transthoracic echocardiography
	IN DEX. 2	2 mcg/kg	50	13.7 ± 8.6 mon.
	IN DEX. 3	3 mcg/kg	50	15.4 ± 8.5 mon.
Lu et al. 2016 [25]	IN DEX.	1 mcg/kg	40	43.6 ± 9.2 yrs.	45–60 min. before anaesthetic induction	Elective suspension laryngoscopy
	A placebo	1 ml	41	45.9 ± 10.1 yrs.
Reynolds et al. 2016 [26]	IN DEX. + oral placebo	3 mcg/kg	44	23.3 mon. (19.5–27.2)	Before the procedure	Auditory brainstem response (ABR) testing
	Oral chloral hydrate + IN saline placebo	50 mg/kg	41	25.6 mon. (22.0–29.0)
Sidhu et al. 2016 [27, 28]	IN DEX.	2 μg/kg	35	5 [2–9], yrs.	30 min. prior to surgery	Various surgeries
	IN clonidine	3 μg/kg	35	5 [2–9], yrs.
	IN Saline	0.5 ml	35	5 [2–9], yrs.
Lin et al. 2016 [29]	IN DEX.	1 mcg/kg	30	4.75 ± 1.86 yrs.	45 min. before induction of anesthesia	Cataract surgery with sevoflurane
	IN DEX.	2 mcg/kg	30	4.04 ± 1.68 yrs.
	IN Saline	Same volume	30	4.15 ± 1.58 yrs.
Wu et al. 2016 [30]	IV Saline	Same volume	27	48 ± 4 yrs.	30 min. following nasal medication	Elective hysterectomy
	IN DEX.	1 µg/kg	26	47 ± 4 yrs.	40 min. before anesthesia induction
	IN DEX,	2 µg/kg	28	47 ± 5 yrs.	40 min. before anesthesia induction
	IV DEX.	1 µg/kg	27	47 ± 5 yrs.	10 min. befyrs.ore anesthesia induction
Neville et al. 2016 [31]	IN DEX.	2 mcg/kg	20	3.44 yrs.	Prior to surgery	Pediatric laceration repairs
	IN Midazolam	0.4 mg/kg	18	3.15 yrs.
Abdelaziz et al. 2016 [32]	IN DEX.	1 mcg/kg	33	2.68 ± 1.54 yrs.	Before entrance to the operation room	Strabismus surgery
	IN Midazolam	0.1 mg/kg	33	2.48 ± 1.17 yrs.
	IN Saline	1 ml	32	2.78 ± 1.67 yrs.
Abd El-Hamid and Yassin. 2017 [33]	IN DEX.	1 mcg/kg	43	4.4 ± 1.3 yrs.	After the induction of general anesthesia	Tonsillectomy and/or adenoidectomy under general anesthesia with sevoflurane
	IN Saline	0.5 ml in each nostril	43	4.2 ± 0.93 yrs.
Shi et al. 2017 [34]	IN Saline 0.01 ml/kg + IV Saline 0.04 ml/kg + Propofol 2 mg/kg		30	26.7 ± 4.8 yrs.	-IN drugs (45 min. before surgery) -IV drugs (During induction of GA)	Termination of first trimester pregnancy
	IN DEX. 0.1 mcg/kg + IV Saline 0.04 ml/kg + Propofol 2 mg/kg		30	28 ± 4.1 yrs.
	IN Saline 0.01 ml/kg + IV Sufentanil 0.1 mcg/kg + Propofol 2 mg/kg		30	27.3 ± 4.5 yrs.
Qiao et al. 2017 [35]	IN DEX.	2.5 mcg/kg	42	3.96 ± 1.50 yrs.	30 min. before the induction of anesthesia	Eye surgery under general anesthesia
	IN DEX. + Oral ketamine	2 mcg/kg +3 mg/kg	41	3.76 ± 1.36 yrs.
	Oral ketamine	6 mg/kg	41	4.41 ± 1.28 yrs.
Cao et al. 2017 [36]	IN DEX.	2 mcg/kg	71	18 [10–25] mon.	Before the procedure	Ophthalmic examinations
	Oral chloral hydrate	80 mg/kg	70	14.5 (8.8–23.2) mon.
Yuen et al. 2017 [37]	Chloral hydrate syrup+ IN Saline spray	50 mg/kg	107	24 mon.	30 min. before the procedure	Computerized tomography
	placebo syrup + IN DEX. Spray	3 mcg/kg	87	32.5 mon.
Ghai et al. 2017 [38]	IN DEX.	2.5 mcg/kg	30	3.8 ± 2.1 yrs.	30 min. after EMLA cream application	CT imaging
	Oral Midazolam	0.5 mg/kg	29	3.1 ± 1.3 yrs.
Millar et al. 2018 [39]	IN DEX.	2.5 mcg/kg	140	12.5 [8–17] mon.	Before the procedure	Outpatient TTEcho
	Oral pentobarbital	5 mg/kg	139	13 [9–17] mon.
GAO et al. 2018 [40]	IN DEX.	2 mcg/kg	30	46.2 ± 10.07 yrs.	30 min. before operation	Dental rehabilitation under GA
	IN Saline	0.02 ml/kg	30	43.6 ± 12.92 yrs.
Li et al. 2018 [41]	IN DEX. 1	1 mcg/kg	30	4.47 ± 1.17 yrs.	25 to 40 min. before surgery	Adenoidectomy with or without tonsillectomy
	IN DEX. 2	2 mcg/kg	30	4.53 ± 1.55 yrs.
	IN Saline	In the same volume	30	4.37 ± 1.3 yrs.
Li et al. 2019 [42]	IN DEX. + buccal placebo	3 mcg/kg	136	35.0 (28.0–44.8) yrs.	30–40 min. before the procedure	Nonpainful Procedural Sedation in Children with Autism
	IN DEX. + buccal midazolam	3 mcg/kg +0.2 mg	139	34 (28.0–46.0) yrs.
Bi et al. 2019 [43]	IN DEX.	1 mcg/kg	20	17.2 ± 6.3 mon.	25 min. before anesthesia induction	Removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy
	IN Saline	0.01 ml/kg	20	18.0 ± 6.6 mon.
Aly.A(2020) [44]	IN DEX.	2 mcg/kg	88	2.8 ± 0.8 yrs	1 h before the procedure	Cardiac catheterization
	IN KETAMINE	.5 mg/kg
	IN DEX +IN KETAMINE	3 mg/kg + 1 mcg/kg
Wang et al(2020) [45]	IN DEX.	2 mcg/kg	60	4.56 ± 0.59 yrs	30 m before the procedure	Dental rehabilitation under GA
	Oral Midazolam	0.5 mg/kg
Arun et al(2022) [46]	IN DEX.	1mcg/kg	60	5.14 ± 160 yrs	30 m before the procedure	Various surgeries
	IN KETAMINE	.5 mg/kg

Figure 2a. Bias graph risk of involved studies.

Figure 2b. Bias summary risk depends on Cochrane risk of bias assessment tool; risk of bias domains includes mainly (bias of selection, performance, detection, attrition, and reporting).

Figure 3. Emergence agitation.

Figure 4. Sedation score.

Figure 5. Nausea and vomiting.

Figure 6. Arterial blood pressure.

Figure 7. Heart rate.

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Data availability statement

On request, the corresponding author will provide the data used to support the study’s conclusions.