Jeizan Pantea, Baharimehr Kimia, Kamvar Radin, Abolghasemi Fard Asal, Zojaji Seyedehhasti, Karimi Amir, Zojaji Ramin
Internal Medicine, Edward Via College of Osteopathic Medicine, Virginia, USA.
Medicine, University of California, Riverside, Riverside, USA.
Cureus. 2025 Apr 4;17(4):e81686. doi: 10.7759/cureus.81686. eCollection 2025 Apr.
Tonsillectomy, with or without adenoidectomy, is a common pediatric surgical procedure that often induces significant preoperative anxiety, affecting both children and their parents. This anxiety can lead to aggressive behaviors, increased distress, and complicated postoperative pain management. Midazolam, often used for its rapid sedative effects, has drawbacks such as the potential for paradoxical reactions and respiratory depression. Alternatively, dexmedetomidine, known for its sedative, anxiolytic, and analgesic properties without significant respiratory depression, is becoming a favored option. The objective of this study is to compare the effectiveness of dexmedetomidine versus midazolam in reducing anxiety, emergence delirium (ED), and postoperative pain in pediatric patients undergoing these procedures. A comprehensive search was conducted using PubMed, MEDLINE, EBSCOhost, and Google Scholar to identify studies from January 1, 2000, to March 1, 2025, comparing the effects of dexmedetomidine and midazolam in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Eligible studies were selected following PRISMA guidelines, with a focus on outcomes related to sedation levels, ED, pediatric anesthesia emergence delirium (PAED) score, use of analgesics, and duration of stay in the post-anesthesia care unit (PACU). Data were analyzed using a random-effects model to accommodate inter-study variability. The meta-analysis included six studies with a total of 668 participants. Dexmedetomidine was associated with significantly lower rates of ED, with an odds ratio (OR) of 0.43 (95% confidence interval (CI): 0.27-0.68, P < 0.01), and lower PAED scores compared to midazolam. Dexmedetomidine also demonstrated superior pain control, requiring less additional analgesia with an OR of 2.11 (95% CI: 1.42-3.12, P < 0.01). However, no significant differences were noted in anesthesia duration, extubation times, or PACU stays. Dexmedetomidine appears to be more effective than midazolam in reducing the incidence of ED and managing postoperative pain in children undergoing tonsillectomy and/or adenoidectomy, without extending recovery times. These findings support the preferential use of dexmedetomidine for pediatric premedication in Tonsillectomy and/or adenoidectomy, potentially improving patient outcomes and satisfaction while maintaining cost-effectiveness in surgical settings.
扁桃体切除术，无论是否同时进行腺样体切除术，都是一种常见的儿科外科手术，常常会引起明显的术前焦虑，影响患儿及其父母。这种焦虑可能导致攻击性行为、更多痛苦以及术后疼痛管理复杂化。咪达唑仑常因其快速镇静作用而被使用，但存在诸如可能出现反常反应和呼吸抑制等缺点。相比之下，右美托咪定以其镇静、抗焦虑和镇痛特性且无明显呼吸抑制而闻名，正成为一种受欢迎的选择。本研究的目的是比较右美托咪定与咪达唑仑在减轻接受这些手术的儿科患者的焦虑、苏醒期谵妄（ED）和术后疼痛方面的效果。使用PubMed、MEDLINE、EBSCOhost和谷歌学术进行了全面检索，以识别2000年1月1日至2025年3月1日期间比较右美托咪定和咪达唑仑对接受扁桃体切除术和/或腺样体切除术的儿科患者影响的研究。按照PRISMA指南选择符合条件的研究，重点关注与镇静水平、ED、儿科麻醉苏醒期谵妄（PAED）评分、镇痛药使用以及在麻醉后护理单元（PACU）的停留时间相关的结果。使用随机效应模型分析数据以适应研究间的变异性。荟萃分析纳入了6项研究，共668名参与者。与咪达唑仑相比，右美托咪定与显著更低的ED发生率相关，优势比（OR）为0.43（95%置信区间（CI）：0.27 - 0.68，P < 0.01），且PAED评分更低。右美托咪定还显示出更好的疼痛控制，需要更少的额外镇痛，OR为2.11（95% CI：1.42 - 3.12，P < 0.01）。然而，在麻醉持续时间、拔管时间或PACU停留时间方面未观察到显著差异。在减少接受扁桃体切除术和/或腺样体切除术的儿童的ED发生率和管理术后疼痛方面，右美托咪定似乎比咪达唑仑更有效，且不会延长恢复时间。这些发现支持在扁桃体切除术和/或腺样体切除术中优先使用右美托咪定进行儿科术前用药，这可能在维持手术环境成本效益的同时改善患者结局和满意度。
