{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:57:39Z","timestamp":1790812659636,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Dexmedetomidine is a selective \u03b1<jats:sub>2<\/jats:sub>\u2010adrenergic agonist originally approved for sedation of adults in the intensive care unit and subsequently approved for procedural sedation in adults undergoing medical procedures. Dexmedetomidine is widely used off\u2010label for procedural sedation in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To evaluate efficacy and safety of monotherapy dexmedetomidine for magnetic resonance imaging procedural sedation of children \u22651month\u2013&lt;17years across three ascending doses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized, double\u2010blind, dose\u2010ranging study of procedural sedation recruited patients at USA and Japanese sites from February 2020 to November 2021. Patients were stratified into Cohort A (\u22651month\u2013&lt;2years) or Cohort B (\u22652\u2013&lt;17years). Cohort A loading doses\/maintenance infusions: 0.5\u2009mcg\/kg\/0.5\u2009mcg\/kg\/h, 1.0\u2009mcg\/kg\/1.0\u2009mcg\/kg\/h, and 1.5\u2009mcg\/kg\/1.5\u2009mcg\/kg\/h. Cohort B loading doses\/maintenance infusions: 0.5\u2009mcg\/kg\/0.5\u2009mcg\/kg\/h, 1.2\u2009mcg\/kg\/1.0\u2009mcg\/kg\/h, and 2.0\u2009mcg\/kg\/1.5\u2009mcg\/kg\/h. Primary endpoint was percentage of overall patients completing MRI without rescue propofol at the high versus low dose. Key secondary endpoint was percentage in each age cohort who did not require propofol at the high versus low dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred twenty\u2010two patients received high\u2010 (<jats:italic>n<\/jats:italic>\u2009=\u200938), middle\u2010 (<jats:italic>n<\/jats:italic>\u2009=\u200942), or low\u2010dose (<jats:italic>n<\/jats:italic>\u2009=\u200942) dexmedetomidine. A greater percentage completed MRI without propofol rescue, while receiving high\u2010 versus low\u2010dose dexmedetomidine (24\/38 [63.2%] vs. 6\/42 [14.3%]) (odds ratio: 10.29, 95% confidence interval: 3.47\u201330.50, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Similar results were seen in both age cohorts. The most common adverse events were bradypnea, bradycardia, hypertension, and hypotension, and the majority were of mild\u2010to\u2010moderate severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Dexmedetomidine was well tolerated. The high dose was associated with meaningfully greater efficacy compared with lower doses. Based on these results, the recommended starting dose for procedural sedation in children \u22651month\u2013&lt;2years is loading dose 1.5\u2009mcg\/kg\/maintenance infusion 1.5\u2009mcg\/kg\/h; children \u22652\u2013&lt;17years is loading dose 2.0\u2009mcg\/kg\/maintenance infusion 1.5\u2009mcg\/kg\/h.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14857","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T12:28:27Z","timestamp":1708086507000},"page":"405-414","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A randomized, <scp>double\u2010blind<\/scp>, <scp>dose\u2010controlled<\/scp> study of the use of dexmedetomidine alone for procedural sedation of children and adolescents undergoing <scp>MRI<\/scp> scans"],"prefix":"10.1111","volume":"34","author":[{"given":"Umar","family":"Khan","sequence":"first","affiliation":[{"name":"Clinical Assistant Professor of Anesthesiology and Pain Management Department of Anesthesiology and Pain Management Children's Health System Texas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-3938","authenticated-orcid":false,"given":"Gregory B.","family":"Hammer","sequence":"additional","affiliation":[{"name":"Professor, Anesthesiology, Perioperative and Pain Medicine, and Pediatrics Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Duncan\u2010Azadi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Division of Pediatric Anesthesiology The University of Oklahoma Health Sciences Center  Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuyuki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Anesthesia National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Chiles","sequence":"additional","affiliation":[{"name":"Post Approval Clinical Development Pfizer, Inc.  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunring","family":"Chime","sequence":"additional","affiliation":[{"name":"Post Approval Clinical Development Pfizer, Inc.  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5124-6236","authenticated-orcid":false,"given":"Phillip","family":"Chappell","sequence":"additional","affiliation":[{"name":"Post Approval Clinical Development Pfizer, Inc.  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-017-0507-7"},{"key":"e_1_2_13_3_1","unstructured":"US Food and Drug Administration. Precedex Package Insert.1999. 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