{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:01:49Z","timestamp":1777042909386,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Combination sedation regimens are widely used in pediatric procedural sedation. However, the efficacy and incidence of post-discharge adverse events between intranasal dexmedetomidine combined with oral chloral hydrate and intranasal dexmedetomidine combined with oral midazolam remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a single-center, prospective, randomized controlled trial. A total of 180 children aged 1\u20136 years with American Society of Anesthesiologists physical status I\u2013II who were scheduled for outpatient procedural sedation between December 2022 and October 2023 were enrolled and randomly assigned to receive intranasal dexmedetomidine combined with oral chloral hydrate (D+C group, n = 90) or intranasal dexmedetomidine combined with oral midazolam (D+M group, n = 90). The primary outcome was first-attempt sedation success. Secondary outcomes included the incidence of caregiver-reported post-discharge adverse events within 48 h, the incidence of peri-sedation adverse events, sedation onset time, procedure duration, recovery time, children\u2019s medication acceptance, and parental satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The first-attempt sedation success rate was significantly higher in the D+M group than in the D+C group (95.56% vs. 86.67%, P = 0.036). Sedation onset time was shorter in the D+C group (P &amp;lt; 0.001), whereas recovery time and peri-sedation adverse events were comparable between the two groups. Children\u2019s medication acceptance and parental satisfaction were lower in the D+C group (P &amp;lt; 0.001). During the 0\u201348 h period after discharge, the D+C group had higher incidences of somnolence, ataxia, and any adverse event (all P &amp;lt; 0.05). Multivariable analysis confirmed that the D+M regimen was independently associated with lower risks of several post-discharge adverse events but a higher risk of behavioral changes. Phi coefficient analysis suggested clustering of adverse events, with neurologic symptoms tending to co-occur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared with the D+C regimen, the D+M regimen provides a higher first-attempt sedation success rate and fewer post-discharge adverse events, although attention to post-discharge behavioral changes remains necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1801603","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T13:20:59Z","timestamp":1777036859000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy and post-discharge adverse events of intranasal dexmedetomidine combined with different oral medications for procedural sedation in children: a randomized controlled trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Haisu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Children\u2019s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Dazu\u2019s Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"College of Pediatrics, Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Children\u2019s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Children\u2019s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents\u2019 Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/0952-8180(94)00001-k","article-title":"The post-anesthesia recovery score revisited","volume":"7","author":"Aldrete","year":"1995","journal-title":"J. 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