DEXMEDETOMIDINE FOR SEDATION IN CHILDREN – A NARRATIVE REVIEW OF CLINICAL EVIDENCE, SAFETY CONSIDERATIONS, AND EMERGING THERAPEUTIC ROLES

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5852

Keywords:

Dexmedetomidine, Children, Pediatric, PICU, Sedation, Anesthesia

Abstract

Dexmedetomidine is a highly selective alfa2-adrenergic agonist increasingly used in pediatric anesthesia and intensive care because of its unique sedative profile and minimal respiratory depressive effects. This narrative summarizes current evidence regarding the pharmacology, pharmacokinetics, clinical efficacy, safety profile and emerging applications of dexmedetomidine in pediatric patients.

Current literature supports the use of dexmedetomidine in multiple clinical settings, including procedural sedation, perioperative management, and pediatric intensive care. The drug has demonstrated efficacy in reducing opioid requirements, preventing emergence agitation and delirium, and providing effective sedation while preserving spontaneous respiration. However, its use remains associated with dose-dependent cardiovascular adverse effects, particularly bradycardia and hypotension, requiring individualized dosing and careful monitoring, especially in neonates and infants due to age-related pharmacokinetic variability.

Emerging evidence suggests potential neuroprotective and organ-protective properties, although robust pediatric clinical data remains limited. Novel applications and alternative administration routes continue to expand the potential role of dexmedetomidine in pediatric practice.

Overall, dexmedetomidine represents a versatile and valuable sedative agent in pediatric medicine, though further high-quality studies are needed to optimize dosing strategies and better define long-term safety outcomes.

References

Buck, M. L. (2010). Dexmedetomidine use in pediatric intensive care and procedural sedation. The Journal of Pediatric Pharmacology and Therapeutics, 15(1), 17–29. https://pmc.ncbi.nlm.nih.gov/articles/PMC3017406/

Plambech, M. Z., & Afshari, A. (2015). Dexmedetomidine in the pediatric population: A review. Minerva Anestesiologica, 81(3), 320–332.

Lee, S. (2019). Dexmedetomidine: Present and future directions. Korean Journal of Anesthesiology, 72(4), 323–330. https://doi.org/10.4097/kja.19259

Lee, I. K., Lee, K. H., Han, H. J., Choi, I. Y., Kim, N. J., & Kim, K. (2025). Dexmedetomidine in mechanically ventilated critically ill children: A systematic review and meta-analysis of randomized controlled trials. Yonsei Medical Journal, 66(8), 473–481. https://doi.org/10.3349/ymj.2024.0299

O'Kane, A., Quinney, S. K., Kinney, E., Bergstrom, R. F., & Tillman, E. M. (2024). A systematic review of dexmedetomidine pharmacology in pediatric patients. Clinical and Translational Science, 17(12), e70020. https://doi.org/10.1111/cts.70020

Jeizan, P., Baharimehr, K., Kamvar, R., Abolghasemi Fard, A., Zojaji, S., Karimi, A., & Zojaji, R. (2025). Dexmedetomidine leads to less emergence delirium compared to midazolam in pediatric tonsillectomy and/or adenoidectomy: A systematic review and meta-analysis. Cureus, 17(4), e81686. https://doi.org/10.7759/cureus.81686

Scheckenbach, V., & Fideler, F. (2025). Optimizing pediatric sedation: Evaluating remimazolam and dexmedetomidine for safety and efficacy in clinical practice. Paediatric Drugs, 27(2), 181–189. https://doi.org/10.1007/s40272-024-00659-1

Guillen-Hernandez, J., Kyllonen, K. C., Tumin, D., & Rodriguez, R. J. (2023). The use of dexmedetomidine in preterm infants: A single academic center experience. Journal of Pediatric Pharmacology and Therapeutics, 28(7), 628–634. https://doi.org/10.5863/1551-6776-28.7.628

McDonald, D., Palsgraf, H., & Shah, P. (2022). Dexmedetomidine - An emerging option for sedation in neonatal patients. Journal of Perinatology, 42(7), 845–855. https://doi.org/10.1038/s41372-022-01351-3

Su, F., & Hammer, G. B. (2011). Dexmedetomidine: Pediatric pharmacology, clinical uses and safety. Expert Opinion on Drug Safety, 10(1), 55–66. https://doi.org/10.1517/14740338.2010.512609

van Hoorn, C. E., Flint, R. B., Skowno, J., Davies, P., Engelhardt, T., Lalwani, K., Olutoye, O., Ista, E., & de Graaff, J. C. (2021). Off-label use of dexmedetomidine in paediatric anaesthesiology: An international survey of 791 (paediatric) anaesthesiologists. European Journal of Clinical Pharmacology, 77(4), 625–635. https://doi.org/10.1007/s00228-020-03028-2

Freriksen, J. J. M., van der Zanden, T. M., Holsappel, I. G. A., Molenbuur, B., & de Wildt, S. N. (2022). Best evidence-based dosing recommendations for dexmedetomidine for premedication and procedural sedation in pediatrics: Outcome of a risk-benefit analysis by the Dutch Pediatric Formulary. Paediatric Drugs, 24(3), 247–257. https://doi.org/10.1007/s40272-022-00498-y

Zekhtser, M., Carroll, E., Boyd, M., & Ambati, S. (2021). The role of dexmedetomidine in pediatric patients presenting with an anticholinergic toxidrome. Case Reports in Critical Care, 2021, 7590960. https://doi.org/10.1155/2021/7590960

Daverio, M., Sperotto, F., Zanetto, L., Coscini, N., Frigo, A. C., Mondardini, M. C., & Amigoni, A. (2020). Dexmedetomidine for prolonged sedation in the PICU: A systematic review and meta-analysis. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21(7), e467–e474. https://doi.org/10.1097/PCC.0000000000002325

Takeuchi, M., Nemoto, S., Suzuki, Y., Takahashi, N., Takenaka, N., Takata, A., & Kobayashi, M. (2021). Age-specific dose regimens of dexmedetomidine for pediatric patients in intensive care following elective surgery: A phase 3, multicenter, open-label clinical trial in Japan. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 22(11), e546–e557. https://doi.org/10.1097/PCC.0000000000002730

Sperotto, F., Mondardini, M. C., Dell'Oste, C., Vitale, F., Ferrario, S., Lapi, M., Ferrero, F., Dusio, M. P., Rossetti, E., Daverio, M., Amigoni, A., & Pediatric Neurological Protection and Drugs (PeNPAD) Study Group of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI) (2020). Efficacy and safety of dexmedetomidine for prolonged sedation in the PICU: A prospective multicenter study (PROSDEX). Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21(7), 625–636. https://doi.org/10.1097/PCC.0000000000002350

Banasch, H. L., Dersch-Mills, D. A., Boulter, L. L., & Gilfoyle, E. (2018). Dexmedetomidine use in a pediatric intensive care unit: A retrospective cohort study. The Annals of Pharmacotherapy, 52(2), 133–139. https://doi.org/10.1177/1060028017734560

Al Mutair, A., Alabbasi, Y., Alshammari, B., Alrasheeday, A. M., Alharbi, H. F., & Aleid, A. M. (2025). A meta-analysis of the impact of intranasal dexmedetomidine on emergence delirium and agitation in children and adolescents undergoing tonsillectomy and/or adenoidectomy. Journal of Clinical Medicine, 14(5), 1586. https://doi.org/10.3390/jcm14051586

Lewis, J., & Bailey, C. R. (2020). Intranasal dexmedetomidine for sedation in children; a review. Journal of Perioperative Practice, 30(6), 170–175. https://doi.org/10.1177/1750458919854885

He, H., Cui, Q., Chen, H., Huang, X., Wang, S., Yu, T., Feng, J., & Shao, Y. (2023). The effect of intranasal dexmedetomidine on emergence delirium prevention in pediatric ambulatory dental rehabilitation under general anesthesia: A randomized clinical trial. Drug Design, Development and Therapy, 17, 3563–3570. https://doi.org/10.2147/DDDT.S427291

Agarwal, S., Agrawal, S., Kamal, G., Gupta, A., Gupta, A., & Kalra, B. (2026). A comparative study of clonidine and dexmedetomidine as an adjuvant to levobupivacaine for caudal analgesia in children undergoing below umbilical surgeries: A randomized double-blind controlled trial. Agri: Agri (Algoloji) Dernegi'nin Yayin Organidir = The Journal of the Turkish Society of Algology, 38(1), 21–28. https://doi.org/10.14744/agri.2025.58672

Azemati, S., Keihani, M., Sahmeddini, M. A., Kanaani Nejad, F., Dehghanpisheh, L., Khosravi, M. B., & Asmarian, N. (2024). Comparing the sedative effects of intranasal dexmedetomidine, midazolam, and ketamine in outpatient pediatric surgeries: A randomized clinical trial. Iranian Journal of Medical Sciences, 49(7), 421–429. https://doi.org/10.30476/ijms.2023.99122.3118

Jin, Q. Q., Cai, W. C., Zhou, Y. F., Zhang, Y. T., Chen, G., Xu, M. T., Li, J., & Yuan, K. M. (2025). Comparison of a ready-to-use intranasal dexmedetomidine spray with traditional intranasal dexmedetomidine drops for sedation in preschool children: A prospective, randomized, controlled study. Frontiers in Pharmacology, 16, 1528612. https://doi.org/10.3389/fphar.2025.1528612

Huda, A. U., Yasir, M., Mughal, M. Z., & Arif, A. (2025). Effect of fixed-dose intravenous dexmedetomidine on emergence delirium after general anesthesia for a surgery in pediatric patients - A randomized controlled trial. Qatar Medical Journal, 2025(3), 95. https://doi.org/10.5339/qmj.2025.95

Ni, J., Wei, J., Yao, Y., Jiang, X., Luo, L., & Luo, D. (2015). Effect of dexmedetomidine on preventing postoperative agitation in children: A meta-analysis. PLOS ONE, 10(5), e0128450. https://doi.org/10.1371/journal.pone.0128450

Huang, L., Wang, L., Peng, W., & Qin, C. (2022). A comparison of dexmedetomidine and propofol on emergence delirium in children undergoing cleft palate surgery with sevoflurane-based anesthesia. The Journal of Craniofacial Surgery, 33(2), 650–653. https://doi.org/10.1097/SCS.0000000000008343

Tervonen, M., Pokka, T., Kallio, M., & Peltoniemi, O. (2020). Systematic review and meta-analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation. Acta Paediatrica (Oslo, Norway: 1992), 109(10), 2008–2016. https://doi.org/10.1111/apa.15348

Inoue, M., & Morita, M. (2024). Total intravenous anesthesia using midazolam and dexmedetomidine as substitutes for propofol in a pediatric patient with egg allergy and a family history of malignant hyperthermia. Saudi Journal of Anaesthesia, 18(4), 573–575. https://doi.org/10.4103/sja.sja_210_24

Cocchi, E., Shabani, J., Aceti, A., Ancora, G., Corvaglia, L., & Marchetti, F. (2025). Dexmedetomidine as a promising neuroprotective sedoanalgesic in neonatal therapeutic hypothermia: A systematic review and meta-analysis. Neonatology, 122(4), 495–504. https://doi.org/10.1159/000546017

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Published

2026-09-10

How to Cite

Faria, G., Wyżykowska, A., Maruszak, M., Grygorowicz, J., Niedziela, M. ., Sas-Wyżykowska, M., Mykhalevych, A., Kryshtofik, A., & Blachucik, A. (2026). DEXMEDETOMIDINE FOR SEDATION IN CHILDREN – A NARRATIVE REVIEW OF CLINICAL EVIDENCE, SAFETY CONSIDERATIONS, AND EMERGING THERAPEUTIC ROLES. International Journal of Innovative Technologies in Social Science, 3(3(51). https://doi.org/10.31435/ijitss.3(51).2026.5852

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