{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T20:16:00Z","timestamp":1794255360693,"version":"4.9.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81971809"],"award-info":[{"award-number":["81971809"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"\n Abstract<\/jats:title>\n Procedural sedation for diagnostic examination is a common practice in children. The study aims to analyze the sedative effect and safety of intranasal dexmedetomidine combined with oral midazolam in outpatient pediatric procedural sedation across different age groups and to assess the incidence of sedation failure. From February 2021 to September 2021, children who underwent procedural sedation were retrospectively enrolled. The children were divided into 4 groups based on age: the infant group (0 to 1\u00a0year old), toddler group (1 to 3\u00a0years old), preschool group (3 to 6\u00a0years old), and school-age group (6 to 12\u00a0years old). Two-mcg\/kg intranasal dexmedetomidine and 0.5-mg\/kg oral midazolam were used for sedation. The sedation success rate after rescue, sedation success rate, onset time of sedation, and the sedation time were recorded. The incidence of adverse events and the risk factors for sedation failure were also analyzed. A total of 4758 patients were identified. After exclusion, 3149 patients were ultimately enrolled. The combination of 2-mcg\/kg intranasal dexmedetomidine and 0.5-mg\/kg oral midazolam resulted in a total success rate of 99.7% and a sedation success rate of 91.4%. The sedation success rate varied among the four groups: 90.2% in the infant group, 93.1% in the toddler group, 92.7% in the preschool group, and 78.4% in the school-age group. The sedation success rate was significantly lower in the school-age group compared to the other three groups (P<\/jats:italic>\u2009<\u20090.001). The onset time of sedation was shorter in infant (22\u00a0min, IQR: 18\u201328\u00a0min, P<\/jats:italic> < 0.001) and longer in the school-age group (30\u00a0min, IQR: 25\u201335\u00a0min, P<\/jats:italic>\u2009<\u20090.05). Additionally, the infants had a longer sedation time (110\u00a0min, IQR: 90\u2013135\u00a0min, P<\/jats:italic>\u2009<\u20090.001) and a higher rate of delayed recovery (27.5%, all P<\/jats:italic>\u2009<\u20090.001). The incidence of adverse events was low (4.70%), which bradycardia (2.03%) being the most common. Age (0\u20131\u00a0year and\u2009>\u20096\u00a0years), weight, ASA class II, and history of\u00a0failed sedation were identified as risk factors of sedation failure.<\/jats:p>\n \u00a0 Conclusion<\/jats:italic>: Intranasal administration of 2-mcg\/kg dexmedetomidine combined with oral administration of 0.5-mg\/kg midazolam was found to be efficient and safety for pediatric procedural sedation. Different age groups of children exhibited distinct sedation characteristics, and age was identified as a risk factor affecting the efficacy of sedation.\n\n \n What is Known:<\/jats:bold>\u2022 Procedural sedation for diagnostic examination is a common practice in children.<\/jats:italic>\u2022 The combination of dexmedetomidine with midazolam can improve sedative effects.<\/jats:italic><\/jats:td>\n <\/jats:tr>\n \n What is New:<\/jats:bold>\u2022 The success rate of sedation using a combination of 2-mcg\/kg intranasal dexmedetomidine and 0.5-mg\/kg oral midazolam was significantly lower in school-age children as compared to infants, toddlers, and preschoolers.<\/jats:italic>\u2022 The onset time of sedation increased with age, and the sedation time was found to be longer in infant patients.<\/jats:italic><\/jats:td>\n <\/jats:tr>\n <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00431-023-05240-5","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T13:02:54Z","timestamp":1697720574000},"page":"169-177","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam"],"prefix":"10.1007","volume":"183","author":[{"given":"Xiaqing","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialian","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiya","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunwei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoqin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"issue":"3","key":"5240_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1136\/adc.2008.153072","volume":"96","author":"E Starkey","year":"2011","unstructured":"Starkey E, Sammons HM (2011) Sedation for radiological imaging. 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All procedures were conducted in accordance with the ethical standards set forth by the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, ensuring compliance and protection of participant rights and confidentiality.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"This is an observational study. The local research ethics committee has confirmed that informed consent is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"N\/A.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}