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This dose-finding study aims to establish the 50% (ED\n                      <jats:sub>50<\/jats:sub>\n                      ) and 90% (ED\n                      <jats:sub>90<\/jats:sub>\n                      ) effective doses of intravenous remimazolam following intranasal dexmedetomidine premedication to optimise this sequential regimen.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-centre trial (March-December 2024), children aged 3 months to 6 years requiring MRI sedation were enrolled. After intranasal dexmedetomidine (3\u00a0\u00b5g\u00b7kg\u207b\u00b9), children adequately sedated by dexmedetomidine alone were excluded. 150 children with inadequate sedation were stratified by age (3\u201312 months, 1\u20133 years, 3\u20136 years) and administered remimazolam via Dixon\u2019s up-and-down method. ED\n                      <jats:sub>50<\/jats:sub>\n                      and ED\n                      <jats:sub>90<\/jats:sub>\n                      with 95%CI were calculated via probit regression. Vital signs, adverse events, awake time, and post-sedation side effects were recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Remimazolam for successful sedation maintained consistent ED\n                      <jats:sub>50<\/jats:sub>\n                      values of 0.12\u00a0mg\u00b7kg\n                      <jats:sup>\u2212\u20091<\/jats:sup>\n                      across all paediatric age groups. ED\n                      <jats:sub>90<\/jats:sub>\n                      values slightly increased from 0.20\u00a0mg\u00b7kg\n                      <jats:sup>\u2212\u20091<\/jats:sup>\n                      in infants and toddlers to 0.23\u00a0mg\u00b7kg\n                      <jats:sup>\u2212\u20091<\/jats:sup>\n                      in preschoolers. MRI was successfully completed in 93.3% of patients, while 6.7% required additional medication during the examination. Adverse events occurred in 15.3% of children, including transient hypotension in 2%, bradycardia in 0.7%, and hypoxia in 0.7%; all events were self-limiting without intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This prospective study defines the ED\n                      <jats:sub>50<\/jats:sub>\n                      and ED\n                      <jats:sub>90<\/jats:sub>\n                      of remimazolam following dexmedetomidine premedication in dexmedetomidine-non-responders for paediatric MRI sedation. The sequential regimen demonstrated consistent weight-based dosing requirements with a favorable safety profile.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The trial was prospectively registered in the Chinese Clinical Trial Registry (chictr.org.cn; No. ChiCTR2400081218) on February 26, 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-03848-2","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T06:11:25Z","timestamp":1776665485000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effective doses of remimazolam for sedation in paediatric magnetic resonance imaging following dexmedetomidine premedication: a dose-finding study"],"prefix":"10.1186","volume":"26","author":[{"given":"Wanjun","family":"Zheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhua","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhipeng","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"3848_CR1","doi-asserted-by":"publisher","first-page":"e700","DOI":"10.1097\/PEC.0000000000002289","volume":"37","author":"KL Johnson","year":"2021","unstructured":"Johnson KL, Cochran J, Webb S. 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