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Background: Delirium is a very frequent alteration of postoperative behavior in children. Tonsillectomy surgery is related to severe sleep apnea and does not indicate benzodiazepine premedication. Non-premedication is directly related to the presence of negative behaviors. Dexmedetomidine is a safe option for children with obstructive sleep apnea (OSA) since it does not affect airway tone. Aims: The main aim of this retrospective observational study is determining whether intranasal dexmedetomidine premedication decreases the incidence of preoperative anxiety, postoperative delirium, and the need for postoperative sedatives and opioids in children undergoing tonsillectomy. Methods: 83 patients aged between 2 and 11 years were enrolled in a retrospective observational study in two groups according to receiving 1 μg/kg of intranasal dexmedetomidine premedication or not. Preoperative anxiety was assessed using the Yale Preoperative Anxiety Scale (YPAS). Postoperative Delirium was measured with the Pediatric Anesthesia Emergency Delirium (PAED) at 15, 30, and one hour after admission into the Postanesthetic Care Unit (PACU). Demographic data, intra-operative analgesics, post-operative opioids and sedatives administered, post-operative bleeding and perioperative respiratory adverse effects (PRAEs) were collected. Results: Study groups were comparable. The incidence of preoperative anxiety was 57.89% in non-premedicated compared to 26.67% in the dexmedetomidine group (p = 0.008). The delirium at 30 minutes was 52.63% in non-premedicated compared to 28.89% in premedicated (p = 0.048). Anxiety or delirium occurred at any time was 92.11% in non-premedicated compared to 68.89% in premedicated patients (p = 0.0194). No statistically significant differences were found in the need for intraoperative or postoperative opioids or postoperative sedatives, bleeding, or PRAEs. No cases of hypotension, bradycardia have occurred. Conclusion: The incidence of preoperative anxiety and delirium in children without premedication is very high. Premedication with 1 μg/kg intranasal dexmedetomidine reduces preoperative anxiety and the incidence of anxiety and delirium at any time in the perioperative period.

Use of Dexmedetomidine in Pediatric Patients for the Decrease of the Postoperative Delirium: Implementation of a Protocol Approved for Premedication