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BACKGROUND: This research aimed to evaluate the analgesic effect of perineural injection or intravenous infusion of dexmedetomidine in ultrasound-guided erector spinae plane block (ESPB) combined with serratus anterior plane block (SAPB) for patients undergoing thoracoscopic surgery. METHODS: In this prospective, double-blind, randomized controlled trial, seventy-five patients scheduled for thoracoscopic surgery were randomly divided into the control group (group R: 40 ml of 0.375% ropivacaine for ESPB combined with SAPB and 40 ml of 0.9% NaCl for intravenous infusion), the intravenous infusion of dexmedetomidine group (group RDiv: 40 ml of 0.375% ropivacaine for ESPB combined with SAPB and 40 ml of 0.9% NaCl containing 1 µg/kg dexmedetomidine for intravenous infusion), and the perineural injection of dexmedetomidine group (group RD: 40 ml of 0.375% ropivacaine containing 1 µg/kg dexmedetomidine for ESPB combined with SAPB and 40 ml of 0.9% NaCl for intravenous infusion). The primary outcome was the duration of effective analgesia, defined as the time from the onset of nerve blocks to the first demand for patient-controlled analgesia. Secondary outcomes included postoperative opioid consumption, rescue analgesia, numeric rating scale (NRS) scores, adverse effects and quality of recovery. RESULTS: Compared with group R and group RDiv, the duration of effective analgesia in group RD was significantly prolonged (1313.8 ± 372.8 vs. 844.5 ± 285.2 vs. 943.0 ± 417.2 min, P < 0.05), opioid consumption and the number of patients who required rescue analgesia were significantly reduced (P < 0.05), and NRS scores at rest and on movement at 24, 36 and 48 h were all significantly reduced (P < 0.05). Group RD exhibited a reduced incidence of postoperative nausea and vomiting (P < 0.05), along with improved quality of recovery-15 score at 24 h postoperatively (P < 0.05). CONCLUSIONS: Perineural injection of dexmedetomidine in ultrasound-guided erector spinae plane block combined with serratus anterior plane block could still significantly prolong the duration of effective analgesia after thoracoscopic surgery, reduce opioid consumption, and improve the occurrence of adverse effects, thereby improving early-term recovery. However, the same clear benefits were not observed with intravenous dexmedetomidine. TRIAL REGISTRATION: The study was registered at Chinese Clinical Trial Registry (https//www.chictr.org.cn) with the number ChiCTR2400088052 on 08/09/2024.

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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.

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1 OBJECTIVE: We aimed to expound the effects of different doses of dexmedetomidine (Dex) combined with stellate ganglion block (SGB) on postoperative pain, sleep quality, and serum orexin A levels in patients undergoing general anesthesia for laparoscopic radical resection for colorectal cancer (CRC). 2 METHODS: This prospective randomized controlled trial enrolled 320 CRC patients, randomly assigned to four groups (n = 80): control (0.9% NaCl + SGB), and three Dex groups receiving low, medium, or high Dex infusion (0.2, 0.4, and 0.6 mcg/kg·h, respectively) combined with SGB. Postoperative pain [Visual Analogue Scale (VAS), postoperative days 1-3], insomnia [Athens Insomnia Scale (AIS), before and after surgery], serum orexin-A levels (enzyme-linked immunosorbent assay), and adverse events were assessed and compared. 3 RESULTS: All Dex groups showed lower VAS scores (postoperative days 1-3), postoperative AIS scores, and serum orexin-A levels than the control group (P < 0.05). These improvements were dose-dependent, with the high-dose group demonstrating the most significant effects. The incidence of adverse events was lower in the Dex groups, with no significant differences across dosage levels (P > 0.05). 4 CONCLUSION: Dex at 0.6 mcg/kg·h combined with SGB provides optimal postoperative analgesia, improves sleep quality, lowers serum orexin-A, and does not significantly increase adverse events.

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BACKGROUND: Opioid-free anesthesia (OFA) offers potential benefits of smoother recovery and reduced complications, compared with conventional opioid-based approach. We aimed to evaluate the use of OFA as an alternative approach to conventional opioid-based anesthetic regimen in patients undergoing supratentorial brain tumor surgery. METHODS: Adult patients (>18 y) with supratentorial tumors undergoing elective craniotomy under general anesthesia (Aug 2022 to Dec 2023) were randomized into Dexmedetomidine (group D) or Fentanyl (group F) group. Primary outcome included emergence and extubation times and secondary outcomes were hemodynamic responses, pain scores, rescue analgesic use, and complications. RESULTS: A total of 44 patients were randomized (22 per group). Of these, 33 patients completed the study. Demographic variables were comparable, except for age and body mass index. Emergence (8.2±3.3 min vs. 6.8±2.6 min [P=0.18]; Mean Difference [MD], 95% CI: 1.42, -0.69 to 3.55) and extubation times (12.7±4.2 min vs. 11.2±3.9 min [P=0.27]; MD, 95% CI: 1.58, -1.31 to 4.46) were comparable between the groups, respectively. Group D demonstrated better hemodynamic stability during Mayfield pin application and tracheal extubation. Postoperative pain scores were similar, except at 12 hours, where group D reported lower Numerical Rating Scale. Postoperative Richmond Agitation-Sedation Scale at different time points was comparable between the groups. CONCLUSION: Our preliminary data suggest that OFA may provide better hemodynamic stability and improved pain control at 12 hours compared with opioid-based anesthesia, while maintaining similar emergence and extubation times.

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IntroductionDuring the newborn period, circumcision is performed under local anesthesia, but for older infants it is typically performed by general surgeons or urologists under general anesthesia. Recent literature debates over a concern for neurotoxicity associated with general anesthesia in the developing brain, and it is important to create techniques to decrease exposure to neurotoxic agents while still allowing safe performance of procedures. We performed a prospective feasibility study performing circumcision with use of caudal block as the primary anesthetic with a natural airway under dexmedetomidine sedation.MethodsThis is a single-institution, prospective comparative study of male patients undergoing outpatient circumcision ages 2 to 24 months. A 1:3 case-control match was utilized. Patients underwent circumcision with natural airway, caudal block, and dexmedetomidine sedation compared to patients performed under general anesthesia. The primary endpoint was successful performance of the operation and secondarily assessed operative times, total-OR times, and intra- and postoperative medication use.Results27 patients were enrolled in the study. Of the 27 patients, 23 (85%) successfully tolerated the procedure after caudal block was performed. Four patients required conversion to placement of an LMA for deeper sedation. Patients had similar OR and operative times, with significantly less Sevoflurane exposure time and less postoperative fentanyl use compared to control.ConclusionCaudal block with intravenous sedation is a feasible alternative to maintaining general anesthesia during circumcision in young patients. It avoids prolonged airway instrumentation and provides adequate intra- and postoperative analgesia without increased postoperative pain or change in expected recovery time.Level of EvidenceLevel 2; prospective comparative study.

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BACKGROUND: This study evaluated the lung-protective effects of esketamine and dexmedetomidine administered before anesthesia induction in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) undergoing video-assisted thoracoscopic surgery (VATS). METHODS: Sixty patients with mild-to-moderate COPD scheduled for VATS who completed the study and were included in the statistical analysis were randomly assigned to four groups (n = 15 per group): Control (Group C, saline), Dexmedetomidine (Group D, 0.8 µg/kg), Esketamine (Group E, 0.25 mg/kg), and Combination (Group ED, dexmedetomidine 0.8 µg/kg plus esketamine 0.25 mg/kg). Arterial blood gases, peak airway pressure (Ppeak), plateau pressure (Pplat), dynamic lung compliance (Cdyn), heart rate (HR), and mean blood pressure (MBP) were measured at different time points. Inflammatory markers (IL-6, IL-8, IL-10, TNF-α), oxidative stress markers (MDA, SOD), intraoperative drug use, postoperative recovery, pain scores, and adverse events were recorded. RESULTS: At T4 (2 h after one-lung ventilation), peak airway pressure (Ppeak) and plateau pressure (Pplat) were significantly lower, and dynamic lung compliance (Cdyn) significantly higher, in Groups E and ED compared to Groups C and D (P < 0.05). At the same time point, levels of IL-6 and IL-8 were significantly lower in Groups E and ED than in Groups C and D (P < 0.05). TNF-α levels were significantly lower in Groups E and ED compared to Group C, and significantly lower in Group ED than in Group D (P < 0.05). IL-10 levels were significantly higher in Groups E and ED than in Groups C and D, with Group E showing higher levels than Group ED (P < 0.05). Similarly, SOD levels were significantly elevated in Groups E and ED compared to Groups C and D, and higher in Group E than in Group ED (P < 0.05). MDA levels were significantly reduced in Groups E and ED compared to Group C, and lower in Group ED than in Group D (P < 0.05). Additionally, PaO2 at T4 was significantly higher in Group ED than in Groups C and D (P < 0.05). CONCLUSIONS: Low-dose esketamine combined with dexmedetomidine, administered before anesthesia induction, improved intraoperative pulmonary mechanics and oxygenation, and attenuated inflammation and oxidative stress in patients with mild-to-moderate COPD undergoing VATS. The combination also helped maintain hemodynamic stability and reduced postoperative pain, contributing to enhanced perioperative recovery.

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Sulfur mustard (SM), a typical alkylating agent, poses significant threats. Inhalational SM exposure causes acute lung injury (ALI) with complex mechanisms and no effective antidotes. we established a murine inhalation model and an in vitro alveolar epithelial cell (MLE-12) model using chloroethyl ethyl sulfide (CEES), a well-characterized SM analog, to explore therapeutic interventions. We found that dexmedetomidine (DEX), a clinically anesthetic with multi-mechanistic properties, effectively mitigated CEES-induced pulmonary histopathological and functional damage, enhancing survival rates in vivo. Transcriptomic profiling revealed that DEX reversed CEES-mediated downregulation of genes involved in hematopoietic lineage differentiation in lung tissues. Further histopathological and hematological analyses revealed that DEX mitigated CEES-triggered bone marrow suppression, splenic white pulp atrophy, peripheral neutrophilia, and serum inflammatory cytokine elevation. DEX also suppressed pulmonary infiltration of neutrophils and monocyte-macrophages, along with reduced inflammatory mediators. Mechanistically, DEX inhibited mitochondria-mediated apoptosis in both lung tissues and MLE-12 cells. Additionally, DEX reduced reactive oxygen species (ROS) and mitochondrial ROS levels, while enhancing SOD1 and glutathione content. Finally, DEX reversed CEES-induced mitochondrial structural damage in type II alveolar epithelial cells and the increase in mtDNA content in lung tissue, ameliorated the decline of mitochondrial membrane potential in MLE-12 cells, and inhibited the downregulation of the mitochondrial Mfn1 in both in vivo and in vitro models. Collectively, our findings underscore DEX's multifaceted protective mechanisms, including modulation of inflammation, apoptosis, oxidative stress, and mitochondrial homeostasis against SM analog-induced ALI.

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INTRODUCTION: Endoscopic submucosal dissection (ESD) is a minimally invasive organ-preserving procedure indicated for the removal of precancerous and cancerous areas in the gastrointestinal (GI) tract. It is highly valuable due to its ability to achieve high en-bloc resection rates and reduced local recurrence. Nevertheless, postoperative pain has been an often-overlooked complication, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9-62.8 %, leading to decreased patient satisfaction. Dexmedetomidine, a selective and potent α2-receptor agonist, has gained recognition in clinical practice for its sedative, analgesic, and anxiolytic properties, with the advantage of not causing respiratory depression as seen with opioids. METHODS: Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of dexmedetomidine on endoscopic submucosal dissection postoperative pain in adult patients with gastrointestinal neoplasias. Primary outcomes were postoperative pain, sedation time and adverse event rate. Data were analyzed using R version 4.2.2. The risk of bias was assessed by the Robins-I and RoB 2 tool. The quality of evidence was graded using the GRADE scale and Newcastle-Ottawa guidelines. RESULTS: Five randomized clinical trials and one observational studies described the postprocedural pain level of dexmedetomidine vs control for gastrointestinal neoplasia dissection, totaling 643 patients. The meta-analysis demonstrated a significant reduction in postoperative pain with dexmedetomidine (RR = 0.50; 95 % CI = [0.35; 0.70]; p < 0.01). No significant difference was found in terms of adverse event rate between -groups (RR = 1.04; 95 % CI = [0.55; 1.98]; p = 0.85). Similarly, regarding sedation time, two randomized clinical trials and one observational study totaling 249 patients showed no significant difference between groups (SMD = 0.27; 95 % CI = [-0.62; 1.17]; p = 0.32). The risk of bias was low with moderate-to-high quality of evidence among the included studies. DISCUSSION: Our updated systematic review and meta-analysis demonstrated a significant difference in the postoperative pain level in the group with concomitant dexmedetomidine and midazolam sedation compared to midazolam alone for the endoscopic dissection of superficial gastrointestinal neoplasias. Importantly, our analysis did not include objective data regarding post procedure opioid consumption nor patient satisfaction; these variables would be valuable for future analysis. Further large-scale randomized control trials are warranted currently to help confirm these findings and to explore the optimal dosing regimens and administration protocols for dexmedetomidine in ESD.

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BACKGROUND: Organ dysfunction after cardiac surgery may be reduced by dexmedetomidine. We evaluated whether perioperative dexmedetomidine reduces complications after cardiac surgery with cardiopulmonary bypass. METHODS: In this randomised, double-blind, placebo-controlled trial conducted in nine Chinese hospitals, adults scheduled for cardiac surgery with cardiopulmonary bypass were randomly assigned to receive i.v. dexmedetomidine (0.4 µg kg-1 h-1) or saline (placebo) for 12 h after the induction of anaesthesia. The co-primary outcomes were in-hospital mortality and major complications after surgery (including stroke, myocardial infarction, heart block, cardiac arrest), analysed by intention-to-treat. Secondary outcomes included individual complications. RESULTS: A total of 1073 participants (46% female; mean age: 54 yr [range: 47-63 yr]) completed the study after randomisation. Major complications occurred in 161/536 (30%) participants who received dexmedetomidine, compared with 169/537 (32%) who received saline (relative risk: 0.93 [95% confidence interval: 0.72-1.21]; P=0.66). In addition, 10/536 (1.9%) participants who received dexmedetomidine died in hospital, compared with 15/537 (2.8%) participants who received saline (odds ratio: 0.66 [95% confidence interval: 0.29-1.49]; P=0.32). Major complications, other than heart block, did not differ between participants who received dexmedetomidine, compared with participants who received saline. Safety outcomes and process measures did not differ between participants allocated to dexmedetomidine or saline. CONCLUSIONS: Perioperative use of dexmedetomidine did not reduce death, complications, or both in adults undergoing cardiopulmonary bypass-assisted cardiac surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT02237495).

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CONTEXT: Pain, agitation, and other refractory symptoms occur commonly in palliative patients. Dexmedetomidine has anxiolytic, analgesic, and sedating effects; however, its use remains uncommon in palliative care. In New Zealand, the Hospice Waikato Inpatient Unit has increasingly used dexmedetomidine since 2019 when symptoms are refractory and deep sedation is not desirable due to patient and prognostic factors. OBJECTIVES: To describe use of subcutaneous dexmedetomidine infusions in the Hospice Waikato Inpatient Unit, noting patient demographics, treatment characteristics, safety factors, and effectiveness. METHODS: A retrospective, observational review of clinical records, using descriptive statistics. RESULTS: Twenty-six infusions in 25 adult patients (≥18 years) were analyzed, of whom 24 (96%) had malignancy. Refractory pain (n=24, 92%) and agitated delirium (n = 13, 50%) were the commonest indications for dexmedetomidine. Median duration was 4 days (interquartile range 2.3-8.8 days). Infusion rates ranged between 0.2 and 1.4 mcg/kg/hr. Side effects occurred in 15 infusions (58%) but none required cessation. Potentiation of opioids, causing sedation, occurred once (4% of infusion events). Hemodynamic monitoring was seldom performed. Median change in Richmond Agitation-Sedation Score (RASS-PAL) over 24 hours was -2 (P = 0.0001) and clinicians perceived dexmedetomidine as effective within 24 hours in 23 cases (88%). Opioid and midazolam requirements often reduced but this effect was less pronounced beyond 24 hours. CONCLUSION: Dexmedetomidine subcutaneous infusion appears to be well-tolerated, safe, and effective in managing pain and agitation, while maintaining patients' ability to interact with family. It may avoid the need for palliative sedation therapy (PST) in some cases.

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INTRODUCTION: Postoperative delirium is a common complication following cardiac surgery. Despite its known impact on patient outcomes, effective preventative strategies remain elusive. We aimed to perform a comprehensive Bayesian network meta-analysis of randomised controlled trials assessing the effect of pharmacological interventions on the incidence of postoperative delirium. METHODS: Databases were searched from inception to September 2024. Our search was updated in January 2025. Eligible studies included randomised controlled trials reporting the incidence of postoperative delirium in patients having cardiac surgery treated with pharmacological interventions. Bayesian models were used to estimate risk ratios (RR) and mean differences with 95%CrI through Markov chain Monte Carlo. Interventions were ranked using the surface under the cumulative ranking curve. Sensitivity analyses and grading of recommendations, assessment, development and evaluation assessment were conducted to evaluate the robustness and certainty of evidence. RESULTS: Seventy-nine randomised controlled trials comprising 24,827 patients were included, with 29 pharmacological interventions compared. Dexmedetomidine combined with melatonin was the most effective intervention, reducing the incidence of postoperative delirium compared with placebo (risk ratio 0.31, 95%CrI 0.13-0.69; low certainty). Dexmedetomidine with melatonin also significantly decreased intensive care unit stay (2.4 days, 95%CrI -3.50-1.10) and hospital stay (1.32 days, 95%CrI -2.09 to -0.57). Other interventions, including ketamine and risperidone, showed potential efficacy but with low or very low certainty of evidence. DISCUSSION: We identified dexmedetomidine with melatonin as the most effective pharmacological strategy for preventing postoperative delirium following cardiac surgery. Whilst these findings highlight potential benefits, the low certainty of evidence underscores the need for more high-quality primary evidence.

After heart surgery, some patients get confused or don't think clearly. This is called postoperative delirium, and it's a common problem. Even though doctors know it's bad for recovery, there aren't many proven ways to stop it. In this study, we looked at many other studies to see which medicines might help prevent this problem. We searched through medical research papers up to September 2024 and updated our search in January 2025. We only included studies where patients had heart surgery and were given medicine to help prevent delirium. We used special mathematical testing models to compare the results of different medicines and see which worked best. We found 79 good studies with a total of 24,827 patients. These studies tested 29 different medicines. The best combination was dexmedetomidine with melatonin. It helped lower the chances of confusion after surgery. Patients who took this combination also stayed for a shorter time in the intensive care unit and hospital. Some other medicines, like ketamine and risperidone, may help too, but we're not very sure about their results. Dexmedetomidine with melatonin seems to be the best medicine mix for stopping confusion after heart surgery. But, because we're not 100% sure about all the results, we still need more strong studies to be certain.

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BACKGROUND: Dexmedetomidine is an a2-adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has gained remarkable attention in the adult and pediatric population predominantly because of its minimal respiratory depression. However, in the pediatric population, very limited information is available regarding the action of intravenous dexmedetomidine on neuromuscular blockade and on anesthesia induction. The aim of this study was to investigate the impact of dexmedetomidine on rocuronium-induced neuromuscular blockade and on anesthesia induction with propofol in children. MATERIAL AND METHOD: A total of 60 children undergoing elective surgery, ages 4-12 years, were enrolled in the study. Before the induction of anesthesia with propofol, 30 children received dexmedetomidine 0.5 µg/kg given over 10 min (group D). Another group of 30 children received the same volume of N/S 0.9% over 10 min as well (group P). We recorded time to achieve TOF = 0 from the end of rocuronium infusion, time for BIS < 60 from the end of propofol infusion, intubation conditions, haemodynamic changes, intubation attempts, and adverse effects. RESULTS: The onset time of rocuronium was significantly lower in group D compared to group P (177.8 s, 95% CI 161.1-194.0 s vs 205 s, 95% CI 188.0-222.0 s; p = 0.021). Time for BIS to reach a value < 60 (34.3 s, 95% CI 29.1-39.6 s for group D vs 33.2 s, 95% CI 27.2-39.2 s for group P, p = 0.772) was unaffected by dexmedetomidine infusion. Intubation conditions showed a more stable haemodynamic response in group D (systolic, diastolic, mean arterial pressure, and heart rate were significantly lower in group D at intubation). No difference was found regarding intubation attempts and adverse effects. CONCLUSION: Our results showed that dexmedetomidine infusion before induction of anesthesia with propofol reduced the onset time of rocuronium and provided a better hemodynamic profile during endotracheal intubation in children. TRIAL REGISTRATION: The study protocol was registered in ClinicalTrials.gov (NCT03923075).

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Dexmedetomidine (DEX), a selective α2-adrenergic receptor agonist, has gained recognition for its sedative, anxiolytic, and sympatholytic properties, making it a valuable perioperative agent. This report describes the anaesthetic management of an elderly 75-year-old male patient with septic shock, multi-organ dysfunction, delirium and significant ventricular arrhythmias who presented in 2025 to a tertiary care teaching hospital in Oman and was scheduled for an emergency below-knee amputation. DEX was utilised for intraoperative sedation and its antiarrhythmic effects. Traditional sedatives often exacerbate delirium or pose cardiorespiratory risks; however, DEX provides effective sedation while preserving respiratory function and promoting haemodynamic stability. Notably, its use contributed to a marked suppression of ventricular ectopy and arrhythmias during surgery, likely through attenuation of the catecholamine surge and reduced myocardial excitability. This case highlights the dual benefit of DEX in managing complex surgical patients with neuropsychiatric and cardiac comorbidities, underscoring its potential as a preferred agent in similar clinical scenarios. Further studies are warranted to explore its broader application in arrhythmia-prone, delirious patients undergoing noncardiac surgeries.

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Dexmedetomidine is a centrally acting selective α2-adrenergic agonist that initially received US Food and Drug Administration approval in 1999 for the sedation of intubated and mechanically ventilated adult patients for up to 24 hours. Since then, it has seen widespread use in clinical practice in various clinical scenarios including sedation during mechanical ventilation, provision of adjunctive analgesia, procedural sedation, treatment of withdrawal, and sedation during end-of-life care. Although traditionally administered intravenously, animal investigations and anecdotal clinical experience has reported efficacy with subcutaneous (SC) administration. Clinical applications of SC dexmedetomidine have included procedural sedation; outpatient and home care where IV administration may not be feasible or interfere with patient comfort; the management or prevention of drug withdrawal symptoms; and during end-of-life care. This educational review outlines the basic physiology of dexmedetomidine, and details reports of its SC administration in laboratory animals as well as various clinical scenarios with a specific focus on its applications in pediatric-aged patients. Techniques for SC administration and dosing schemes are presented.

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Background: Dexmedetomidine, despite its wide-ranging benefits, may also pose a risk of delayed recovery in the postanesthesia care unit (PACU). Few studies have examined the relationship between dexmedetomidine and delayed recovery in the PACU after lung resection. Therefore, this retrospective cohort study aimed to investigate the effect of dexmedetomidine on PACU recovery time. Methods: This study identified 1,397 eligible patients [dexmedetomidine-free (NO-DEX) group, n = 638; intraoperative dexmedetomidine use (DEX) group, n = 759] among 1,980 patients undergoing lung resection from January 2020 to December 2023. The primary outcome was the relationship between dexmedetomidine exposure and the risk of prolonged PACU recovery time; secondary outcomes were independent risk factors affecting PACU recovery time. The data were analyzed using propensity score matching and univariate and multivariate logistic regression analyses, as appropriate. In addition, we also developed a nomogram, which was evaluated using the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results: After propensity score matching, there were 521 patients in each group. The incidence of PACU recovery time exceeding 60 min was 25.48%. Univariate logistic regression analysis showed that intraoperative dexmedetomidine use was associated with the risk of prolonged PACU recovery time [odds ratio (OR): 1.58; 95% confidence interval (CI): 1.18-2.11; p = 0.002]. Multivariate logistic regression analysis also showed a significant difference in the risk of prolonged PACU recovery time (OR: 1.60; 95% CI: 1.19-2.15; p = 0.002) between the NO-DEX and DEX groups. Sensitivity analyses under varying assumptions confirmed the robustness of our primary results. Independent risk factors for delayed recovery in the PACU included intraoperative dexmedetomidine use, advanced age, smoking, cardiovascular disease, and ASA physical status III, whereas regional block was associated with reduced risk. The predictive nomogram demonstrated moderate discrimination and estimated a 70% probability of delayed PACU recovery in patients presenting with all identified risk factors. Conclusion: Our data demonstrated that intraoperative dexmedetomidine use was associated with prolonged PACU recovery time following lung resection, potentially increasing the pressure on busy recovery rooms.