Dexmedetomidine for Emergence Delirium and Agitation in Preschool Children Undergoing Adeno-Tonsillectomy: A Scoping Review Protocol.

Abstract

Emergence delirium (ED) and emergence agitation (EA) are behavioural disturbances in the early postoperative period in children. Preschool-aged children (1-6 years) undergoing adeno-tonsillectomy constitute a high-risk group. The α₂-adrenergic agonist dexmedetomidine has emerged as a potential preventive/therapeutic agent for ED/EA, but evidence in this specific subgroup is fragmented. To map and characterise the body of evidence regarding dexmedetomidine use for preventing or managing ED/EA in preschool children undergoing adeno-tonsillectomy. A scoping review will be conducted in accordance with JBI methodology and reported via the PRISMA-ScR checklist. Searches will be performed in MEDLINE, Embase, CINAHL, CENTRAL, and grey literature. Eligible studies will include preschool (1-6 years) children undergoing adeno-tonsillectomy where dexmedetomidine was used perioperatively. Two reviewers will screen and extract data independently. Data will be charted on dexmedetomidine dosing, routes, timing, outcome definitions, effects on ED/EA, secondary outcomes, and adverse events. A descriptive synthesis will identify evidence patterns and gaps. This review will provide the first consolidated overview of dexmedetomidine use specifically in preschool children undergoing adeno-tonsillectomy for ED/EA prevention or management. The findings may inform clinical practice and guide future targeted trials.