Nebulized Dexmedetomidine for Sedation and Mask Acceptance in Pediatric Patients Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Purpose: Compare nebulized dexmedetomidine to other sedatives while assessing the level of sedation, mask acceptance, and parental separation anxiety in the pediatric population undergoing surgery.

Design: Systematic review and meta-analysis.

Methods: MEDLINE (PubMed), Google Scholar, CINAHL, the Cochrane Review Database, Google Scholar, and gray literature were searched for evidence. Risk ratio (RR) and standardized mean difference (SMD) were used to estimate outcomes with suitable effect models. The quality of evidence was rated using the Risk of Bias and the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Findings: Eight studies (n = 615) were included in the review. Over 30 minutes following premedication, nebulized dexmedetomidine yielded comparable sedation scores to other nebulized treatments (SMD, -0.09; 95% confidence interval [CI], -0.45 to 0.28; P = .64). Subgroup analyses revealed that nebulized dexmedetomidine provided more satisfactory sedation levels compared with midazolam (SMD, -0.82; 95% CI, -1.37 to -0.26; P = .004), although it did not provide a satisfactory sedation level as ketamine (SMD, 0.34; 95% CI, 0.01 to 0.67; P = .04). Furthermore, patients receiving nebulized dexmedetomidine showed higher rates of satisfactory mask acceptance (RR, 1.32; 95% CI, 1.08 to 1.59; P = .007) and favorable parental separation outcomes (RR, 1.17; 95% CI, 1.04 to 1.32; P = .01).

Conclusions: Nebulized dexmedetomidine is efficacious versus nebulized midazolam but not nebulized ketamine for preprocedural sedation for pediatric patients undergoing general anesthesia. Nonetheless, it demonstrated superior results in facilitating parental separation and mask acceptance.