Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2025 11 29 1 15 Kaiying Song Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Ling Li Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Peijun Li Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Xuetao Yan Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Yongmei Zhao Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Zigang Liu Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China Huiqin Lu Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China 2025 02 10 2025 08 31 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. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4338 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4338/2267