Comparative Study of Dexmedetomidine Administration Routes in Pediatric Patients Receiving Endoscopic Low-temperature Plasma Adenotonsillar Ablation
-
Kaiying Song
,
Ling Li
,
Peijun Li
,
Xuetao Yan
,
Yongmei Zhao
,
Zigang Liu
,
Huiqin Lu
Abstract
This study aimed to explore the effects of different dexmedetomidine (DEX) administration routes on anesthesia quality in pediatric patients undergoing endoscopic low-temperature plasma adenotonsillar ablation.
We selected 120 children with obstructive sleep apnea hypopnea syndrome scheduled for surgery between May and December 2023. Participants were divided into four groups (n=30 each): a control group (Group S) receiving standard anesthesia without DEX; a local anesthesia group (Group L) receiving ropivacaine infiltration with 0.3 µg·kg−1 DEX; an intravenous group (Group T) receiving 0.6 µg·kg−1 DEX infusion post-induction; and a nasal drip group (Group N) receiving 0.6 µg·kg−1 DEX intranasally upon room entry. We compared operation/extubation/recovery times, and scores from the Observer Assessment of Alertness and Sedation (OAA/S), Objective Pain Scale (OPS), and Pediatric Anesthesia Emergence Delirium (PAED) scales. Rescue sedation and safety were also assessed.
Group T showed lower heart rates at specific timepoints, while Group L had lower blood pressures. Recovery time (Steward score ≥4) was longer in Groups L and T compared to Group S, but not in Group N. Groups T and N showed increased OAA/S scores post-awakening, with Group N having the highest scores. OPS and PAED scores decreased in all DEX groups, with Group N demonstrating the lowest scores, followed by Group L and then Group T. No significant differences were found in operation time, extubation time, or the incidence of rescue sedation/complications among groups.
Intranasal DEX emerged as the optimal route, providing effective analgesia and sedation without prolonging recovery time.
1. Lv R, Zhao Y, Wang Z, Liu X, Wang Z, Li S, et al. Obstructive sleep apnea hypopnea syndrome in ancient traditional Chinese medicine. Sleep Breath. 2023;27(4):1597-610.
2. Iannella G, Magliulo G, Greco A, de Vincentiis M, Ralli M, Maniaci A, et al. Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment. Int J Environ Res Public Health. 2022;19(4).
3. Zeng GH, Xu G, Liu HY, Gao Z. Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome in children. Medicine (Baltimore). 2022;101(43):e31505.
4. Shi N, Pang F, Chen J, Lin M, Liang J. Abnormal interaction between cortical regions of obstructive sleep apnea hypopnea syndrome children. Cereb Cortex. 2023;33(19):10332-40.
5. Hosseini HR, Ngan P, Tai SK, Andrews LJ 2nd, Xiang J. A comparison of skeletal and dental changes in patients with a Class II relationship treated with clear aligner mandibular advancement and Herbst appliance, followed by comprehensive orthodontic treatment. Am J Orthod Dentofacial Orthop. 2024;165(2):205-19.
6. Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020;11(11):CD013449.
7. Combs D, Edgin J, Hsu CH, Bottrill K, Van Vorce H, Gerken B, et al. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2023;19(12):2065-73.
8. Abijay CA, Tomkies A, Rayasam S, Johnson RF, Mitchell RB. Children with Down syndrome and obstructive sleep apnea: outcomes after tonsillectomy. Otolaryngol Head Neck Surg. 2022;166(3):557-64.
9. Ashrafizadeh M. Cell death mechanisms in human cancers: molecular pathways, therapy resistance and therapeutic perspective. J Cancer Biomol Ther. 2024;1(1):17-40.
10. Liu Z, Li S, Mu S, Yang Z, Li J, Ding L, et al. The efficacy of cryogenic plasma tonsillectomy in the treatment of obstructive sleep apnea-hypopnea syndrome in children: a meta-analysis. Pediatr Pulmonol. 2023;58(3):834-43.
11. Zhong J, Luo X, Qiu S, Cheng C, Zhou Y, Chen L, et al. Preliminary study on efficacy and safety of submucosal plasma ablation of inferior turbinate in children with allergic rhinitis complicated with obstructive sleep apnea syndrome. J Clin Otorhinolaryngol Head Neck Surg. 2022;36(10):758-62.
12. Varadharajan K, Caton N, Faulkner J, Khemani S. Coblation intracapsular tonsillectomy in children with recurrent tonsillitis: initial experience. Int J Pediatr Otorhinolaryngol. 2020;135:110113.
13. Wu Y, Zhang N, Wang L, Zhang Q, Yuan Q, Wang X, et al. Effect of tonsillotomy on the inflammation and immune function in children with chronic tonsillitis. J Clin Otorhinolaryngol Head Neck Surg. 2023;37(4):297-301.
14. St Rose T, Carr SN, Phillips AK, Reeder NP, Relf MV. Improving identification of pediatric emergence delirium in the post anesthesia care unit: a quality improvement opportunity. J Perianesth Nurs. 2022;37(6):770-3.
15. Bhardwaj S, Devgan S, Sood D, Katyal S. Comparison of local wound infiltration with ropivacaine alone or ropivacaine plus dexmedetomidine for postoperative pain relief after lower segment cesarean section. Anesth Essays Res. 2017;11(4):940-5.
16. Duan S, Zhou S. Dexmedetomidine and perioperative arrhythmias. J Cardiothorac Vasc Anesth. 2024;38(5):1221-7.
17. Persson N, Uusalo P, Nedergaard M, Lohela TJ, Lilius TO. Could dexmedetomidine be repurposed as a glymphatic enhancer? Trends Pharmacol Sci. 2022;43(12):1030-40.
18. Lin J, Wu C, Zhao D, Du X, Zhang W, Fang J. The sedative effects of inhaled nebulized dexmedetomidine on children: a systematic review and meta-analysis. Front Pediatr. 2022;10:865107.
19. Zhao GG, Lou C, Gao RL, Lei FX, Zhao J. Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer. World J Gastrointest Oncol. 2024;16(7):2952-9.
20. Lee-Archer P, McBride C, Paterson R, Reade M, Regli-von Ungern-Sternberg B, Long D. Does dexmedetomidine given as a premedication or intraoperatively reduce post-hospitalisation behaviour change in children? A study protocol for a randomised controlled trial in a tertiary paediatric hospital. BMJ Open. 2018;8(4):e019915.
21. Shioji N, Everett T, Suzuki Y, Aoyama K. Pediatric sedation using dexmedetomidine and remimazolam for magnetic resonance imaging. J Anesth. 2022;36(1):1-4.
22. Hao J, Wu Z, Luo Z, Dong B. Addition of dexmedetomidine to ropivacaine for local infiltration anaesthesia improves analgesic efficacy after tonsillectomy and adenoidectomy: a randomized controlled trial. Int J Pediatr Otorhinolaryngol. 2020;137:110168.
23. Zhang T, Li H, Lin C, An R, Lin W, Tan H, et al. Effects of an intraoperative intravenous bolus dose of dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial. Eur J Clin Pharmacol. 2024;80(3):465-74.
24. He J, Zhang X, Li C, Fu B, Huang Y, Li H. Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia. BMC Anesthesiol. 2024;24(1):42.
25. Pateron B, Marianowski R, Monteyrol PJ, Couloigner V, Akkari M, Chalumeau F, et al. French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(4):265-8.
26. Randall DA. Current indications for tonsillectomy and adenoidectomy. J Am Board Fam Med. 2020;33(6):1025-30.
27. Lew MW, Pozhitkov A, Rossi L, Raytis J, Kidambi T. Machine learning algorithm to perform the American Society of Anesthesiologists physical status classification. Cureus. 2023;15(10):e47155.
28. El-Tawansy A, Mohamed Salama Elnajar A, Abdel Baky Mahmoud H, Ibrahim Amin M, Abd Elmohsen Bedewy A. Validity of airway ultrasound in correlation with Cormack-Lehane grading in obese patients: a cross-sectional study. Anesth Pain Med. 2024;14(2):e142701.
29. Zhou Y, Xu Z, Liu X, Liu Z, An L, Zhang S, et al. Application of TCM nursing in post-anesthesia recovery room under integrated management mode. Altern Ther Health Med. 2024;AT8395-AT.
30. Nakamura H, Makiguchi T, Yamada Y, Sakurai K, Tsunoda A, Tomaru N, et al. Surgery with peripheral nerve block under dexmedetomidine sedation for foot ulcer. Plast Reconstr Surg Glob Open. 2024;12(11):e6333.
31. Abduallah MA, Al-Ahwal LA, Ahmed SA. Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: randomized controlled study. Pain Pract. 2022;22(4):440-6.
32. Lütze C, Weber TP, Lücke T, Gude P, Georgevici AI. Incidence of emergence delirium after homeostasis-guided pediatric anesthesia for ear-nose-throat surgery. Minerva Anestesiol. 2024;90(7-8):644-53.
33. Tomas VG, Hollis N, Ouanes JP. Regional anesthesia for vascular surgery and pain management. Anesthesiol Clin. 2022;40(4):751-73.
34. Guilliams KP, Harrar D. Ketamine for status epilepticus in children: searching for the right drug for the right patient. Neurocrit Care. 2024;40(1):45-7.
35. Vasakova J, Duskova J, Lunackova J, Drapalova K, Zuzankova L, Starka L, et al. Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry. Physiol Res. 2020;69(Suppl 2):S305-14.
36. Lim JY, Ker CJ, Lai NM, Romantsik O, Fiander M, Tan K. Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev. 2024;5(5):CD012361.
37. Tan I, Barin E, Butlin M, Avolio AP. Relationship between heart rate and central aortic blood pressure: implications for assessment and treatment of isolated systolic hypertension in the young. Minerva Med. 2022;113(5):807-16.
38. Tisotti T, Valverde A, Hopkins A, O’Sullivan ML, Hanna B, Arroyo L. Use of intravenous lidocaine to treat dexmedetomidine-induced bradycardia in sedated and anesthetized dogs. Vet Anaesth Analg. 2021;48(2):174-86.
39. Lu Y, Peng C, Xie L, Wu Y, Gu L, Li S. Nasal drip of dexmedetomidine for optimal sedation during PICC insertion in pediatric burn care. Medicine (Baltimore). 2023;102(6):e32831.
40. Wilkens HL, Neudeck S, Kästner SB. Nasal and tracheobronchial nitric oxide production and its influence on oxygenation in horses undergoing total intravenous anaesthesia. BMC Vet Res. 2022;18(1):134.
41. Ke J, Pen X. The effect of dexmedetomidine on post-operative blood pressure after controlled hypotension in endoscopic sinus surgery. J Clin Otorhinolaryngol Head Neck Surg. 2013;27(10):478-80.
42. Dong R, Li F, Li B, Chen Q, Huang X, Zhang J, et al. Effects of an early intensive blood pressure-lowering strategy using remifentanil and dexmedetomidine in patients with spontaneous intracerebral hemorrhage: a multicenter, prospective, superiority, randomized controlled trial. Anesthesiology. 2024;141(1):100-15.
43. Bala R, Arora V, Anshul A, Arora R, Kamal K, Malhan S. A comparative study of intravenous dexmedetomidine with local infiltration of ropivacaine in attenuation of stress response to skull pin insertion in craniotomies. Asian J Neurosurg. 2022;17(3):463-9.
44. Kovoor JG, Bacchi S, Stretton B, Gupta AK, Lam L, Jiang M, et al. Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions. ANZ J Surg. 2023;93(10):2426-32.
45. Ramgopal S, Sepanski RJ, Crowe RP, Martin-Gill C. External validation of empirically derived vital signs in children and comparison to other vital signs classification criteria. Prehosp Emerg Care. 2024;28(2):253-61.
46. Carnet Le Provost K, Kepp O, Kroemer G, Bezu L. Trial watch: dexmedetomidine in cancer therapy. Oncoimmunology. 2024;13(1):2327143.
47. Chang ET, Certal V, Song SA, Zaghi S, Carrasco-Llatas M, Torre C, et al. Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review. Sleep Breath. 2017;21(3):727-35.
48. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing delirium and agitation in the older emergency department patient: the ADEPT tool. Ann Emerg Med. 2020;75(2):136-45.
49. Advances in combination therapy for gastric cancer: integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15.
50. Zhuang K, Yang HT, Long YQ, Liu H, Ji FH, Peng K. Dexmedetomidine and acute kidney injury after non-cardiac surgery: a meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2024;43(3):101359.
51. Long X, Wen LX, Yang H, Zhu GH, Zhang QY, Jiang JJ, et al. ED95 of remimazolam in nasal administration for attenuating preoperative anxiety in children. Front Med. 2023;10:1253738.
52. Jin Y, Shen L, Ye R, Zhou M, Guo X. Development and validation of a novel score for predicting perioperative major adverse cardiovascular events in patients with stable coronary artery disease undergoing noncardiac surgery. Int J Cardiol. 2024;405:131982.
2. Iannella G, Magliulo G, Greco A, de Vincentiis M, Ralli M, Maniaci A, et al. Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment. Int J Environ Res Public Health. 2022;19(4).
3. Zeng GH, Xu G, Liu HY, Gao Z. Association between mean platelet volume and obstructive sleep apnea-hypopnea syndrome in children. Medicine (Baltimore). 2022;101(43):e31505.
4. Shi N, Pang F, Chen J, Lin M, Liang J. Abnormal interaction between cortical regions of obstructive sleep apnea hypopnea syndrome children. Cereb Cortex. 2023;33(19):10332-40.
5. Hosseini HR, Ngan P, Tai SK, Andrews LJ 2nd, Xiang J. A comparison of skeletal and dental changes in patients with a Class II relationship treated with clear aligner mandibular advancement and Herbst appliance, followed by comprehensive orthodontic treatment. Am J Orthod Dentofacial Orthop. 2024;165(2):205-19.
6. Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020;11(11):CD013449.
7. Combs D, Edgin J, Hsu CH, Bottrill K, Van Vorce H, Gerken B, et al. The combination of atomoxetine and oxybutynin for the treatment of obstructive sleep apnea in children with Down syndrome. J Clin Sleep Med. 2023;19(12):2065-73.
8. Abijay CA, Tomkies A, Rayasam S, Johnson RF, Mitchell RB. Children with Down syndrome and obstructive sleep apnea: outcomes after tonsillectomy. Otolaryngol Head Neck Surg. 2022;166(3):557-64.
9. Ashrafizadeh M. Cell death mechanisms in human cancers: molecular pathways, therapy resistance and therapeutic perspective. J Cancer Biomol Ther. 2024;1(1):17-40.
10. Liu Z, Li S, Mu S, Yang Z, Li J, Ding L, et al. The efficacy of cryogenic plasma tonsillectomy in the treatment of obstructive sleep apnea-hypopnea syndrome in children: a meta-analysis. Pediatr Pulmonol. 2023;58(3):834-43.
11. Zhong J, Luo X, Qiu S, Cheng C, Zhou Y, Chen L, et al. Preliminary study on efficacy and safety of submucosal plasma ablation of inferior turbinate in children with allergic rhinitis complicated with obstructive sleep apnea syndrome. J Clin Otorhinolaryngol Head Neck Surg. 2022;36(10):758-62.
12. Varadharajan K, Caton N, Faulkner J, Khemani S. Coblation intracapsular tonsillectomy in children with recurrent tonsillitis: initial experience. Int J Pediatr Otorhinolaryngol. 2020;135:110113.
13. Wu Y, Zhang N, Wang L, Zhang Q, Yuan Q, Wang X, et al. Effect of tonsillotomy on the inflammation and immune function in children with chronic tonsillitis. J Clin Otorhinolaryngol Head Neck Surg. 2023;37(4):297-301.
14. St Rose T, Carr SN, Phillips AK, Reeder NP, Relf MV. Improving identification of pediatric emergence delirium in the post anesthesia care unit: a quality improvement opportunity. J Perianesth Nurs. 2022;37(6):770-3.
15. Bhardwaj S, Devgan S, Sood D, Katyal S. Comparison of local wound infiltration with ropivacaine alone or ropivacaine plus dexmedetomidine for postoperative pain relief after lower segment cesarean section. Anesth Essays Res. 2017;11(4):940-5.
16. Duan S, Zhou S. Dexmedetomidine and perioperative arrhythmias. J Cardiothorac Vasc Anesth. 2024;38(5):1221-7.
17. Persson N, Uusalo P, Nedergaard M, Lohela TJ, Lilius TO. Could dexmedetomidine be repurposed as a glymphatic enhancer? Trends Pharmacol Sci. 2022;43(12):1030-40.
18. Lin J, Wu C, Zhao D, Du X, Zhang W, Fang J. The sedative effects of inhaled nebulized dexmedetomidine on children: a systematic review and meta-analysis. Front Pediatr. 2022;10:865107.
19. Zhao GG, Lou C, Gao RL, Lei FX, Zhao J. Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer. World J Gastrointest Oncol. 2024;16(7):2952-9.
20. Lee-Archer P, McBride C, Paterson R, Reade M, Regli-von Ungern-Sternberg B, Long D. Does dexmedetomidine given as a premedication or intraoperatively reduce post-hospitalisation behaviour change in children? A study protocol for a randomised controlled trial in a tertiary paediatric hospital. BMJ Open. 2018;8(4):e019915.
21. Shioji N, Everett T, Suzuki Y, Aoyama K. Pediatric sedation using dexmedetomidine and remimazolam for magnetic resonance imaging. J Anesth. 2022;36(1):1-4.
22. Hao J, Wu Z, Luo Z, Dong B. Addition of dexmedetomidine to ropivacaine for local infiltration anaesthesia improves analgesic efficacy after tonsillectomy and adenoidectomy: a randomized controlled trial. Int J Pediatr Otorhinolaryngol. 2020;137:110168.
23. Zhang T, Li H, Lin C, An R, Lin W, Tan H, et al. Effects of an intraoperative intravenous bolus dose of dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial. Eur J Clin Pharmacol. 2024;80(3):465-74.
24. He J, Zhang X, Li C, Fu B, Huang Y, Li H. Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia. BMC Anesthesiol. 2024;24(1):42.
25. Pateron B, Marianowski R, Monteyrol PJ, Couloigner V, Akkari M, Chalumeau F, et al. French Society of ENT (SFORL) guidelines (short version) on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(4):265-8.
26. Randall DA. Current indications for tonsillectomy and adenoidectomy. J Am Board Fam Med. 2020;33(6):1025-30.
27. Lew MW, Pozhitkov A, Rossi L, Raytis J, Kidambi T. Machine learning algorithm to perform the American Society of Anesthesiologists physical status classification. Cureus. 2023;15(10):e47155.
28. El-Tawansy A, Mohamed Salama Elnajar A, Abdel Baky Mahmoud H, Ibrahim Amin M, Abd Elmohsen Bedewy A. Validity of airway ultrasound in correlation with Cormack-Lehane grading in obese patients: a cross-sectional study. Anesth Pain Med. 2024;14(2):e142701.
29. Zhou Y, Xu Z, Liu X, Liu Z, An L, Zhang S, et al. Application of TCM nursing in post-anesthesia recovery room under integrated management mode. Altern Ther Health Med. 2024;AT8395-AT.
30. Nakamura H, Makiguchi T, Yamada Y, Sakurai K, Tsunoda A, Tomaru N, et al. Surgery with peripheral nerve block under dexmedetomidine sedation for foot ulcer. Plast Reconstr Surg Glob Open. 2024;12(11):e6333.
31. Abduallah MA, Al-Ahwal LA, Ahmed SA. Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: randomized controlled study. Pain Pract. 2022;22(4):440-6.
32. Lütze C, Weber TP, Lücke T, Gude P, Georgevici AI. Incidence of emergence delirium after homeostasis-guided pediatric anesthesia for ear-nose-throat surgery. Minerva Anestesiol. 2024;90(7-8):644-53.
33. Tomas VG, Hollis N, Ouanes JP. Regional anesthesia for vascular surgery and pain management. Anesthesiol Clin. 2022;40(4):751-73.
34. Guilliams KP, Harrar D. Ketamine for status epilepticus in children: searching for the right drug for the right patient. Neurocrit Care. 2024;40(1):45-7.
35. Vasakova J, Duskova J, Lunackova J, Drapalova K, Zuzankova L, Starka L, et al. Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry. Physiol Res. 2020;69(Suppl 2):S305-14.
36. Lim JY, Ker CJ, Lai NM, Romantsik O, Fiander M, Tan K. Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev. 2024;5(5):CD012361.
37. Tan I, Barin E, Butlin M, Avolio AP. Relationship between heart rate and central aortic blood pressure: implications for assessment and treatment of isolated systolic hypertension in the young. Minerva Med. 2022;113(5):807-16.
38. Tisotti T, Valverde A, Hopkins A, O’Sullivan ML, Hanna B, Arroyo L. Use of intravenous lidocaine to treat dexmedetomidine-induced bradycardia in sedated and anesthetized dogs. Vet Anaesth Analg. 2021;48(2):174-86.
39. Lu Y, Peng C, Xie L, Wu Y, Gu L, Li S. Nasal drip of dexmedetomidine for optimal sedation during PICC insertion in pediatric burn care. Medicine (Baltimore). 2023;102(6):e32831.
40. Wilkens HL, Neudeck S, Kästner SB. Nasal and tracheobronchial nitric oxide production and its influence on oxygenation in horses undergoing total intravenous anaesthesia. BMC Vet Res. 2022;18(1):134.
41. Ke J, Pen X. The effect of dexmedetomidine on post-operative blood pressure after controlled hypotension in endoscopic sinus surgery. J Clin Otorhinolaryngol Head Neck Surg. 2013;27(10):478-80.
42. Dong R, Li F, Li B, Chen Q, Huang X, Zhang J, et al. Effects of an early intensive blood pressure-lowering strategy using remifentanil and dexmedetomidine in patients with spontaneous intracerebral hemorrhage: a multicenter, prospective, superiority, randomized controlled trial. Anesthesiology. 2024;141(1):100-15.
43. Bala R, Arora V, Anshul A, Arora R, Kamal K, Malhan S. A comparative study of intravenous dexmedetomidine with local infiltration of ropivacaine in attenuation of stress response to skull pin insertion in craniotomies. Asian J Neurosurg. 2022;17(3):463-9.
44. Kovoor JG, Bacchi S, Stretton B, Gupta AK, Lam L, Jiang M, et al. Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions. ANZ J Surg. 2023;93(10):2426-32.
45. Ramgopal S, Sepanski RJ, Crowe RP, Martin-Gill C. External validation of empirically derived vital signs in children and comparison to other vital signs classification criteria. Prehosp Emerg Care. 2024;28(2):253-61.
46. Carnet Le Provost K, Kepp O, Kroemer G, Bezu L. Trial watch: dexmedetomidine in cancer therapy. Oncoimmunology. 2024;13(1):2327143.
47. Chang ET, Certal V, Song SA, Zaghi S, Carrasco-Llatas M, Torre C, et al. Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: a systematic review. Sleep Breath. 2017;21(3):727-35.
48. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing delirium and agitation in the older emergency department patient: the ADEPT tool. Ann Emerg Med. 2020;75(2):136-45.
49. Advances in combination therapy for gastric cancer: integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15.
50. Zhuang K, Yang HT, Long YQ, Liu H, Ji FH, Peng K. Dexmedetomidine and acute kidney injury after non-cardiac surgery: a meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2024;43(3):101359.
51. Long X, Wen LX, Yang H, Zhu GH, Zhang QY, Jiang JJ, et al. ED95 of remimazolam in nasal administration for attenuating preoperative anxiety in children. Front Med. 2023;10:1253738.
52. Jin Y, Shen L, Ye R, Zhou M, Guo X. Development and validation of a novel score for predicting perioperative major adverse cardiovascular events in patients with stable coronary artery disease undergoing noncardiac surgery. Int J Cardiol. 2024;405:131982.
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| Adenoidectomy Anesthesia recovery period Child Dexmedetomidine Postoperative complications Tonsillectomy | ||
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How to Cite
1.
Song K, Li L, Li P, Yan X, Zhao Y, Liu Z, Lu H. Comparative Study of Dexmedetomidine Administration Routes in Pediatric Patients Receiving Endoscopic Low-temperature Plasma Adenotonsillar Ablation. Iran J Allergy Asthma Immunol. 2025;:1-15.
