# Comment on “A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children”

## TL;DR

This paper critiques a small trial comparing two drugs for sedating children during medical procedures, suggesting the results may be unreliable due to the small sample size and other limitations.

## Contribution

Highlights methodological flaws and limitations in a pediatric sedation trial, urging larger and more comprehensive studies.

## Key findings

- The trial's small sample size likely led to false-negative results.
- Safety and pharmacokinetic issues raise concerns about the drugs' clinical use.
- Larger trials with objective measures and long-term follow-up are needed.

## Abstract

This comment critiques a trial comparing intranasal dexmedetomidine (DEX) and esketamine (sKET) for pediatric procedural sedation. Despite a large effect size, the small sample (n = 29) likely caused false-negative results (p = 0.09), 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.