Reported Safety and Sedation Outcomes of Intranasal Dexmedetomidine as a Sole Sedative for Magnetic Resonance Imaging (MRI) in Children: A Systematic Review and Meta-Analysis

Background: Magnetic resonance imaging (MRI) in children may require sedation to minimize motion artifacts and obtain diagnostic-quality images. Intranasal dexmedetomidine (IN DEX) is increasingly used as a non-invasive sedation option; however, evidence regarding its reported effectiveness and safety as a sole agent in routine clinical practice remains limited. This systematic review and meta-analysis aimed to evaluate the reported efficacy and safety of IN DEX monotherapy for pediatric MRI. Methods: A systematic search of PubMed, MEDLINE, and Embase via Ovid, Scopus, Web of Science, and the Cochrane Library was conducted for studies published from 17 December 1999 to 10 January 2026. Observational studies involving pediatric patients undergoing MRI with IN DEX as the sole sedative agent were included. Outcomes included sedation success, rescue sedation use, bradycardia, hypotension, sedation onset time, and MRI duration. Random-effects meta-analyses were performed, and methodological quality was assessed using the National Institutes of Health quality assessment tool. Results: Twelve observational studies comprising 1828 children were included. The pooled reported sedation success rate was 84% (95% CI: 73–95%), and rescue sedation was required in 19% (95% CI: 8–29%) of cases. The pooled incidences of bradycardia and hypotension were 3% (95% CI: 0–6%) and 1% (95% CI: 0–3%), respectively; no clinically significant events requiring intervention were reported. The pooled mean sedation onset time was 18.4 min, and the pooled mean MRI duration was 38.9 min. Substantial heterogeneity was observed across the efficacy outcomes. Conclusion: Intranasal dexmedetomidine appears to be a feasible and well-tolerated option for pediatric MRI sedation. Although pooled observational data suggest high reported sedation success and low adverse-event rates, findings should be interpreted cautiously because of substantial heterogeneity across studies.