Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844820
Brazilian Journal of Anesthesiology
Review Article

Efficacy and safety of preoperative intranasal dexmedetomidine in adults: a systematic review and meta-analysis of randomized controlled trials

Eficácia e segurança da dexmedetomidina intranasal pré-operatória em adultos: uma revisão sistemática e metanálise de ensaios clínicos randomizados

Vitaliy Voznyy, Mouad Elganga, Leya Tawfik, Tony Tan, Sammie Yu, Ellene Yan, Aparna Saripella, Marina F. Englesakis, Frances Chung

http://dx.doi.org/10.1016/j.bjane.2026.844820 Braz J Anesthesiol, vol.76, n5, 844820, 2026
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Abstract

Background

Airway manipulation during General Anesthesia (GA) can produce sympathetic activation and hemodynamic instability. Intravenous (IV) dexmedetomidine attenuates these responses but may cause bradycardia or hypotension. Intranasal (IN) administration is a noninvasive alternative with uncertain evidence in adults. We evaluated preoperative IN dexmedetomidine in adult patients undergoing GA.

Methods

We performed a PROSPERO-registered (CRD420251250492) systematic review and meta-analysis of randomized trials. MEDLINE, Embase, CENTRAL, and CDSR were searched from inception to November 26, 2025. IN dexmedetomidine versus control and IN vs. IV dexmedetomidine were assessed separately. Random-effects models pooled continuous outcomes as MDs/SMDs and adverse events as RRs. Risk of bias was assessed using RoB2 and certainty of evidence using GRADE.

Results

Across 25 trials including 1,968 patients, IN dexmedetomidine was associated with deeper sedation (SMD = 0.76; 95% CI: 0.18–1.34) and reduced heart rate and mean arterial pressure at induction, intubation, and during the early intraoperative period compared with control (MD range: -12.7 to -13.4 bpm and -7.8 to -10.7 mmHg, respectively). Rates of bradycardia and hypotension were similar between IN dexmedetomidine and control groups. Compared with IV dexmedetomidine, IN administration resulted in lighter sedation (SMD = -0.54; 95% CI: -1.08 to -0.01), with similar hemodynamic effects, while bradycardia and hypotension occurred less frequently.

Conclusion

Preoperative IN dexmedetomidine may improve sedation and blunt peri-induction hemodynamic responses compared with controls, with broadly similar hemodynamic effects and fewer observed cardiovascular adverse events versus IV administration. However, certainty was low or very low for several efficacy outcomes, and larger well-designed trials are needed.

Keywords

Administration, Intranasal; Adult; Anesthesia; General; Dexmedetomidine; Hemodynamics; Meta-analysis as topic

Resumo

Introdução

A manipulação das vias aéreas durante a anestesia geral (AG) pode produzir ativação simpática e instabilidade hemodinâmica. A dexmedetomidina intravenosa (IV) atenua essas respostas, mas pode causar bradicardia ou hipotensão. A administração intranasal (IN) é uma alternativa não invasiva com evidências incertas em adultos. Avaliamos a dexmedetomidina IN pré-operatória em pacientes adultos submetidos à AG.

Metódos

Realizamos uma revisão sistemática e metanálise de ensaios randomizados registrada no PROSPERO (CRD420251250492). As bases de dados MEDLINE, Embase, CENTRAL e CDSR foram consultadas desde o início até 26 de novembro de 2025. A dexmedetomidina IN versus controle e a dexmedetomidina IN versus IV foram avaliadas separadamente. Modelos de efeitos aleatórios agruparam desfechos contínuos como diferenças médias (DM)/diferenças médias padronizadas (DMP) e eventos adversos como riscos relativos (RR). O risco de viés foi avaliado por meio do RoB2 e a certeza da evidência utilizando a metodologia GRADE.

Resultados

Em 25 ensaios que incluíram 1.968 pacientes, a dexmedetomidina IN foi associada a uma sedação mais profunda (DMP = 0,76; IC 95% 0,18–1,34) e à redução da frequência cardíaca e da pressão arterial média na indução, intubação e durante o período intraoperatório precoce em comparação com o controle (faixa de DM: -12,7 a -13,4 bpm e -7,8 a -10,7 mmHg, respectivamente). As taxas de bradicardia e hipotensão foram semelhantes entre os grupos dexmedetomidina IN e controle. Em comparação com a dexmedetomidina IV, a administração IN resultou em sedação mais leve (DMP = -0,54; IC 95% -1,08 a -0,01), com efeitos hemodinâmicos semelhantes, ao passo que a bradicardia e a hipotensão ocorreram com menor frequência.

Conclusão

A dexmedetomidina IN pré-operatória pode melhorar a sedação e atenuar as respostas hemodinâmicas peri-indução em comparação com os controles, com efeitos hemodinâmicos amplamente semelhantes e menos eventos adversos cardiovasculares observados em relação à administração IV. No entanto, a certeza foi baixa ou muito baixa para diversos desfechos de eficácia, sendo necessários ensaios maiores e bem desenhados.

Palavras-chave

Administração intranasal; Adulto; Anestesia geral; Dexmedetomidina; Hemodinâmica; Metanálise como assunto

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Submitted date:
03/17/2026

Accepted date:
07/31/2026

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