Dexmedetomidine Leads to Less Emergence Delirium Compared to Midazolam in Pediatric Tonsillectomy and/or Adenoidectomy: A Systematic Review and Meta-Analysis.

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.