The anxiolytic effect of dexmedetomidine in adult perioperative patients: a systematic review with meta-analysis of randomized controlled trials

Abstract

Background Perioperative anxiety in adults is common and impairs postoperative recovery. The use of dexmedetomidine during perioperative procedures is increasing, but evidence on its effects on anxiety-related outcomes remains to be systematically synthesized. Methods This systematic review was based on searches of PubMed, Embase, Web of Science, MEDLINE, and the Cochrane Library from database inception through May 4, 2026. Eligible studies were randomized controlled trials evaluating perioperative dexmedetomidine in adults and reporting quantitative anxiety outcomes. Results Twelve RCTs involving 1,373 participants were included. Overall anxiety scores were lower with dexmedetomidine than with control (SMD = −0.73; 95% CI [−1.37, −0.10]; P = 0.028; I² = 94.2%; 95% prediction interval [−2.97, 1.50]). Within 24 h after surgery, the pooled estimate likewise favored dexmedetomidine (6 RCTs; SMD = −0.83; 95% CI [−1.58, −0.07]; P = 0.038; I² = 92.9%; 95% prediction interval [−2.76, 1.11]). The estimates for intraoperative anxiety, anxiety at 24–72 h postoperatively, and anxiety beyond 72 h were SMDs = 0.08 (95% CI [−2.31, 2.46]), −0.11 (95% CI [−0.41, 0.20]), and −0.31 (95% CI [−1.02, 0.39]), respectively. Postoperative sleep quality favored dexmedetomidine (4 RCTs; SMD = −0.64; 95% CI [−0.81, −0.48]; I² = 0%), whereas no clear between-group differences were observed for depression or pain. Conclusion Perioperative dexmedetomidine was associated with reduced anxiety in adult surgical patients. Although the evidence for this association was clearer within 24 h after surgery, the limited data across time windows do not establish that the anxiolytic effect is confined to this period. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251129414.