To investigate the effects of intranasal dexmedetomidine hydrochloride nasal spray combined with lidocaine aerosol on anesthesia induction compliance, hemodynamics, stress response, and postoperative outcomes in children undergoing general anesthesia for adenoidectomy.

The pediatric patients who underwent adenoidectomy were divided into control group and treatment group based on their preoperative anesthesia protocol. Pediatric patients in the control group received intranasal dexmedetomidine hydrochloride nasal spray 2 μg·kg^-1 30 minutes before surgery. The control group received intranasal dexmedetomidine, while the treatment group received intranasal dexmedetomidine hydrochloride nasal spray 2 μg·kg^-1 combined with lidocaine aerosol 2 mg·kg^-1 30 minutes before surgery. A comparison was made between the two groups regarding preoperative anxiety, induction compliance, hemodynamic parameters, stress response markers, emergence agitation and pain, anesthesia recovery indices, and length of hospital stay, along with the incidence of adverse reactions.

A total of 82 pediatric patients were enrolled, with 39 cases in control group and 43 cases in treatment group. At anesthesia induction, the modified Yale Preoperative Anxiety Scale (m-YPAS) scores in the control and treatment groups were (26.56±5.13) and (23.14±4.91) points, respectively; the induction compliance checklist (ICC) scores were (0.81±0.26) and (0.69±0.12) points, respectively; the anesthesia induction time were (5.16±1.28) and (4.48±1.01) min, respectively. At T1, the heart rates (HR) in the control and experimental groups were (94.37±8.63) and (90.15±8.82) beats·min^-1, respectively, and the mean arterial pressures (MAP) were (72.63±5.81) and (69.58±5.75) mmHg, respectively; at T2, the HR values were (101.26±10.76) and (95.87±10.35) time·min^-1, respectively, and the MAP values were (78.94±7.44) and (74.23±6.72) mmHg, respectively; at T4, the HR values were (98.58±10.08) and (94.13±9.14) beats·min^-1, respectively, and the MAP values were (77.85±7.24) and (73.92±6.98) mmHg, respectively. Postoperative day 1, the serum cortisol (Cor) levels in the control and experimental groups were (331.67±48.47) and (309.42±45.87) ng·mL^-1, respectively; serotonin (5-HT) levels were (1.54±0.33) and (1.37±0.29) μmol·L^-1, respectively; norepinephrine (NE) levels were (195.73±20.35) and (184.67±21.42) ng·L^-1, respectively; glutamate (Glu) levels were (5.62±0.87) and (5.15±0.82) mmol·L^-1, respectively. At 30 minutes after extubation, the pediatric anesthesia emergence delirium scale (PAED) scores in the control and treatment groups were (4.06±1.37) and (3.28±1.13) points, respectively; the Face, Legs, Activity, Cry, Consolability Scale (FLACC) scores were (3.24±0.85) and (2.79±0.74) points, respectively; and the incidence of emergence agitation was 20.51% (8 cases/39 cases) and 4.65% (2 cases/43 cases), respectively. The comparisons of the above indicators showed statistically significant differences (all P<0.05). The adverse drug reactions in the control group and the experimental group mainly included cough, nausea and vomiting, laryngospasm, and bradycardia and the total incidence of adverse events was 12.82% (5 cases/39 cases) and 9.30% (4 cases/43 cases), respectively (P>0.05).

The intranasal administration of dexmedetomidine hydrochloride nasal spray combined with lidocaine aerosol for general anesthesia in pediatric adenoidectomy effectively alleviates preoperative anxiety, improves cooperation during induction, maintains hemodynamic stability, reduces surgical stress response, and decreases the incidence of emergence agitation and postoperative pain, with a good safety profile, demonstrating significant clinical promotion value.