Pediatric anesthesia & critical care
Efficacy and Safety of Dexmedetomidine‐Esketamine Versus Dexmedetomidine Alone as Premedication for Pediatric Anesthesia Induction: A Systematic Review, Meta‐Analysis, and Trial Sequential Analysis
Authors' conclusion
The intranasal DEX-ESK combination was associated with improved outcomes compared with DEX monotherapy for pediatric premedication including reductions in ED incidence, a modest acceleration in sedation onset, improved mask acceptance, and slightly shorter PACU length of stay, without an increased risk of adverse events.
Study context
- Population
- Pediatric patients undergoing surgery, premedication for anesthesia induction
- Participants
- 466 patients · 5 randomized controlled trials (RCTs)
- Comparison
- Intranasal DEX-ESK vs dexmedetomidine (DEX) alone as premedication
- Outcome
- Emergence delirium (ED) incidence and onset of sedation
Methodological detailsrandom-effects model, trial sequential analysis, Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
- Random-effects model
- Trial sequential analysis
- GRADE
Pooled result
As reported in the abstract
DEX-ESK vs DEXRelative risk (95% CI)P value
ED incidence
0.58(0.35–0.97)
P = 0.04DEX-ESK vs DEXMD, min (95% CI)P value
Time to sedation onset
−3.95(−4.77 to −3.14)
P < 0.01Further pooled results
Mask acceptance score
- Improved mask acceptance, MD
- −0.77
- 95% CI
- −1.27 to −0.27
- P
- P < 0.01
- Random-effects model
FLACC pain score
- Reduced FLACC pain scores, MD
- −0.36
- 95% CI
- −0.70 to −0.02
- P
- P = 0.04
- Random-effects model
Post-anesthesia care unit (PACU) LOS
- Shorter PACU LOS, MD (min)
- −1.83
- 95% CI
- −2.75 to −0.91
- P
- P < 0.01
- Random-effects model
Safety
- Adverse event incidence did not differ significantly between groups
Original publication
Efficacy and Safety of Dexmedetomidine‐Esketamine Versus Dexmedetomidine Alone as Premedication for Pediatric Anesthesia Induction: A Systematic Review, Meta‐Analysis, and Trial Sequential Analysis. Paediatr Anaesth. Published 10 March 2026. doi:10.
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