Biro Y, Tabi Y, Gileles-Hillel A, Rekhtman D. Evaluating the safety and efficacy of rapid bolus-only dexmedetomidine for pediatric EEG sedation: a retrospective study. Eur J Pediatr. 2025 Nov 18;184(12):772. doi: 10.1007/s00431-025-06567-x. PMID: 41251877; PMCID: PMC12627106.

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Abstract
Dexmedetomidine is an α2-adrenergic receptor agonist known for its sedative and analgesic properties. It produces an EEG pattern resembling Stage II sleep without interfering with EEG interpretation, making it a preferred agent for pediatric sedation, particularly during EEG procedures. Traditionally administered as a bolus followed by continuous infusion, this approach can challenge workflow efficiency and staffing in resource-limited settings. This study aimed to evaluate the safety and efficacy of a rapid bolus-only dexmedetomidine protocol for pediatric EEG sedation. This retrospective study included pediatric patients aged 1-18 years undergoing EEG with sedation at the Hadassah Medical Center between 2015 and 2023. All patients received dexmedetomidine via intravenous bolus (1-2 mcg/kg), with additional doses (0.5-2 mcg/kg) as needed. No continuous infusion was used. Primary outcomes were sedation success rate, time to onset and recovery, and adverse events. A total of 345 patients were included. Sedation was successfully achieved in 99% of cases, with a median sedation onset of 5 min. The overall adverse event rate was 8.4%, with no sentinel events. Hypotension and hypoxia occurred in 1.7% of patients each. Patients with upper airway abnormalities were more likely to require additional doses (P = 0.001) and showed a trend toward increased adverse events (P = 0.095). Adverse event risk increased with higher total dexmedetomidine doses (≥ 3 mcg/kg, P = 0.001). Conclusion: Rapid bolus administration of dexmedetomidine without continuous infusion provides effective sedation for pediatric EEG, with a good safety profile, similar to other sedation protocols. This cost-effective approach offers significant advantages for settings with limited staffing or high patient turnover. What is Known: • Dexmedetomidine is well known as an effective agent for EEG procedural sedation. What is New: • We present a novel IV single bolus protocol utilizing dexmedetomidine that demonstrates a high success rate in achieving adequate sedation, is associated with a low incidence of adverse events, and requires an overall lower dosage compared to traditional methods.

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Holbrook JS, Kane JM, Han M, Barrowman N, Bencsics L, Abe MK, Tsze DS. Impact of Body Mass Index on Adverse Events in Children Undergoing Sedation for MRI. Hosp Pediatr. 2025 Oct 1;15(10):852-860. doi: 10.1542/hpeds.2025-008455. PMID: 41016726.

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Abstract
Objectives: More than 20% of children in the United States have a nonhealthy body mass index (BMI). Magnetic resonance imaging is a common procedure necessitating sedation in children, including those with nonhealthy BMI values. We aimed to determine the risk of adverse events (AEs) and airway interventions associated with BMI in this population.

Methods: A retrospective cross-sectional study of children undergoing sedation for MRI at 66 centers participating in the Pediatric Sedation Research Consortium was conducted. BMI values were categorized as underweight, healthy weight, overweight, obesity, and severe obesity. Outcomes were AEs and airway interventions. AEs were categorized as major, moderate, or minor, and airway interventions were categorized as major or minor. We used multivariable logistic regression to determine the risk of AEs and airway interventions associated with BMI.

Results: We analyzed 39 393 children; 3132 (8%) were underweight, 5476 (13.9%) were overweight, 4446 (11.2%) had obesity, and 1123 (2.9%) had severe obesity. Risk of major and moderate AEs in children categorized as underweight, overweight, obesity, and severe obesity were adjusted odds ratio (aOR) 1.22 (95% CI: 1.04-1.4), 1.58 (95% CI 1.41-1.74), 1.8 (95% CI 1.55-2.04), and 1.86 (95% CI 1.59-2.13), respectively. Risk of major airway interventions in those with BMI values in the overweight, obesity, and severe obesity categories were aOR 1.61 (95% CI 1.44-1.78), 1.83 (95% CI 1.58-2.09), and 1.9 (95% CI 1.62-2.18).

Conclusions: Children undergoing sedation for MRI categorized as overweight, obesity, and severe obesity are at increased odds of AEs and airway interventions. Children who are underweight have increased odds of AEs.

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Oune WFB, Splieth CH, Modawi H, Schmoeckel J, Mourad MS. Satisfaction with dental treatment performed under nitrous oxide sedation: prospective questionnaire-based study. Eur J Paediatr Dent. 2025 Sep 1:1. doi: 10.23804/ejpd.2025.2352. Epub ahead of print. PMID: 40931980.

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Abstract
Aim: Nitrous oxide sedation is an effective and safe pharmacological behaviour management technique that has been used in dentistry for many decades. The aim of this study was to assess the patients’, accompanying adults’ and dentists’ satisfaction with dental treatment under nitrous oxide sedation.

Materials: This questionnaire-based study was conducted at the Department of Preventive and Pediatric Dentistry at the University of Greifswald in Germany. A questionnaire was distributed to eligible patients (n=51), accompanying adults and treating dentists. The opinions of accompanying adults and dentists were assessed by means of Visual Analogue Scale (VAS).

Conclusion: Most patients, accompanying adults, and dentists expressed high satisfaction with dental treatment under nitrous oxide, as it effectively enhanced the cooperation making the treatment in the majority of cases possible and more acceptable.

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Hamdan S, Adelou S, Jungo S, Diakonoff H, Treluyer JM, Fron Chabouis H, Smail-Faugeron V. Drugs for Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-analysis. Drugs R D. 2025 Sep;25(3):179-193. doi: 10.1007/s40268-025-00522-9. Epub 2025 Aug 13. PMID: 40804602; PMCID: PMC12460213.

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Abstract
Background and objectives: Performing medical procedures on children can often be challenging because of the anxiety that these procedures may induce, the need for immobility that they may require, or age-related development capabilities. We assessed the effects of procedural sedation and analgesia drugs for anxiety management in children during medical procedures.

Methods: We searched PubMed Medline, Cochrane Library, American Academy of Pediatrics, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and references of eligible studies. We included parallel-arm randomized controlled trials comparing different active drugs of procedural sedation and analgesia in children undergoing diagnostic or therapeutic, painful or nonpainful procedures. Two authors independently screened titles/abstracts, reviewed full-texts, and extracted data related to study characteristics, methodology, participants, and results. Meta-analyses involved the Mantel-Haenszel random-effects approach.

Results: We included 98 studies (9161 children) in the qualitative analysis and 50 in the quantitative analysis. The probability of successful sedation rate was associated with dexmedetomidine versus midazolam alone (odds ratio [OR] 7.42, 95% confidence interval [CI] 4.08-13.48) and with midazolam and ketamine combined versus midazolam alone (OR 3.0, 95% CI 1.67-5.39). The probability of successful sedation rate was associated with dexmedetomidine 2 μg/kg versus 1 μg/kg (OR 5.21, 95% CI 1.90-14.27).

Conclusions: Dexmedetomidine, and the combination of midazolam and ketamine, seem interesting for sedating children during medical procedures.

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Moxham L, Golam A, West NC, Görges M, Whyte SD. Pharmacodynamic Safety Endpoints for Propofol Anesthesia in Children by Age and Sex: A Multicohort Observational Study. Paediatr Anaesth. 2025 Dec;35(12):1071-1079. doi: 10.1111/pan.70031. Epub 2025 Aug 11. PMID: 40788031; PMCID: PMC12603877.

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Abstract
Background: Propofol is a commonly used intravenous sedative and general anesthetic, with rapid onset and short duration of action. It has a narrow therapeutic index and significant interindividual variability in dosing requirements, which may elevate risks of its use, particularly in children.

Aims: We aimed to quantify the doses required to induce loss of consciousness and apnea in children by age and sex to contribute to tailored propofol dosing recommendations for improved safety and efficacy in pediatric anesthesia.

Methods: In this stratified- and purposive-sampling study, we enrolled children in six groups based on sex and age (3- to 5-year-olds, 6- to 10-year-olds, 11- to 18-year-olds), targeting 60 participants per group. For induction of anesthesia, we administered propofol at a constant rate until apnea was reached (absence of end-tidal CO2 for 20 s) up to a maximum dose of 10 mg/kg. We measured the propofol dose required to reach pharmacodynamic endpoints, including loss of eyelash reflex (LOER) and apnea, and estimated the effect of sex and age on these doses.

Results: Data were available for 318 participants, with 162 females and a median (interquartile range) age of 8.1 (5.3-12.9) years. The mean (SD) propofol dose to LOER was 2.65 (0.69) mg/kg with no effect of sex (-0.10 mg/kg for male, 95% confidence interval (CI) -0.26 to 0.05, p = 0.183) or age (0.0 mg/kg per year, 95% CI -0.02 to 0.02, p = 0.876). The mean (SD) propofol dose to apnea was 6.82 (1.64) mg/kg, with significant effects of both sex (+0.67 mg/kg for male, 95% CI 0.30 to 1.03, p < 0.001) and age (-0.14 mg/kg per year, 95% CI -0.19 to -0.1, p < 0.001). Apnea was not reached in 62 participants.

Conclusions: Older and female children exhibited narrower therapeutic indices for the margin between LOER and apnea. This requires heightened vigilance, especially when maintaining spontaneous respiration. A planned genome-wide association study may identify pharmacogenetic-pharmacodynamic relationships and correlations with genetic ancestry.

Trial registration: The trial was registered on clinicaltrials.gov before enrolment (NCT04164264; date of registration 2019-11-15).