Dexmedetomidine as premedication in children: a narrative review

Abstract

Background: Emergence delirium is a frequent complication in children during recovery after general anesthesia. Dexmedetomidine, an α2-adrenergic receptor agonist, has significant sedative and analgetic actions, but there is still little evidence for the effects of premedication in the pediatric population.

Objectives: This study aimed to assess the effects of dexmedetomidine as a premedication drug in children.

Methods: A literature search was conducted for articles published in English that matched the keywords ‘dexmedetomidine’, ‘premedication’ and ‘children’ in PubMed, Embase and the Web of Science database to identify important literature such as randomized controlled trials (RCT), meta-analyses and systematic reviews regarding this issue. Additional papers were identified from the references of the retrieved literature.

Results: The results suggested positive effects on anxiety, emergence delirium, anesthetic requirements, pain, and a small positive effect on postoperative nausea and vomiting. Caution is advised because of the possible development of bradycardia and hypotension after bolus administration intravenously. However, dexmedetomidine did not cause any clinically significant cardiorespiratory events when administered intranasally. An important disadvantage of dexmedetomidine was a delay in extubation and emergence time. Nevertheless, preoperatively administered dexmedetomidine had no significant effects on the discharge from PACU and the hospital discharge.

Conclusions: Dexmedetomidine as premedication in children is valuable and safe. No severe adverse events were reported.