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Despite a large effect size, the small sample (<jats:italic>n<\/jats:italic>\u2009=\u200929) likely caused false-negative results (<jats:italic>p<\/jats:italic>\u2009=\u20090.09), necessitating larger trials. Safety concerns (e.g., aspiration risk), unaddressed long-term psychological outcomes, and limited pharmacokinetic data (delayed DEX onset, prolonged duration) challenge clinical applicability. Future studies should integrate objective measures and long-term follow-up.<\/jats:p>","DOI":"10.1186\/s13049-025-01403-5","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T11:03:16Z","timestamp":1747134196000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comment on \u201cA randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children\u201d"],"prefix":"10.1186","volume":"33","author":[{"given":"Jiajing","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"issue":"1","key":"1403_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13049-024-01190-5","volume":"32","author":"A Nikula","year":"2024","unstructured":"Nikula A, Lundeberg S, Ryd Rinder M, L\u00e4\u00e4peri M, Sandholm K, Castr\u00e9n M, Kurland L. 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