title: The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine.
  
  
  METHODS
  We identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries.
  
  
  METHODS
  Pediatrics who underwent interventional procedures and surgeries.
  
  
  METHODS
  Children under the age of 18.
  
  
  METHODS
  Studies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally.
  
  
  METHODS
  We pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.
  
  
  RESULTS
  This meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was -2.45 (random, 95% CI; -3.33, -1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95% CI; 0.26, 0.68 I2=45%) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was -0.41 (random, 95% CI; -1.09, 0.27 I2=69%) for continuous outcomes and RR was 0.43 (M-H, random 95% CI; 0.32, 0.58 I2=0%) for dichotomous outcomes compared to that of per os benzodiazepines.
  
  
  CONCLUSIONS
  This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesia and Pain Medicine, College of Medicine, Hanyang University, Seoul, South Korea. Electronic address: swj0208@hanyang.ac.kr.
authors.forename: Woo Jong
authors.initials: WJ
authors.lastname: Shin
authors.affiliation: Department of Anesthesia and Pain Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Suin
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Hyeong Sik
authors.initials: HS
authors.lastname: Ahn
authors.affiliation: Department of Anesthesia and Pain Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Oh
mesh_terms: D000278:Administration, Buccal; D000281:Administration, Intranasal; D000284:Administration, Oral; D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000758:Anesthesia / Q000379:methods*; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D020927:Dexmedetomidine
keywords: Dexmedetomidine; Intranasal; Meta-analysis; Randomized controlled trials; Sedation; Systematic review