Intranasal Dexmedetomidine as Sedative for Medical Imaging in Young Children: A Systematic Review to Provide a Roadmap for an Evidence-Guided Clinical Protocol

Round 1

Reviewer 1 Report

In my opinion, the Authors conducted this systematic review with a rigorous methodological approach and reported the data accurately. In addition, it seems to me that the idea to build from the results a roadmap on aspects to be considered in the development of clinical protocols is useful and meets a need for clinicians involved in procedural sedation and analgesia.

I suggest only minimal revisions.

In the DISCUSSION Authors could:

- explain why they suggest the use of RSS rather than UMSS for the sedation monitoring aspect;

- add considerations as to why vomiting was an AE of particular interest;

- elaborate on additional doses topic (which drug, by which route of administration).

Author Response

In my opinion, the Authors conducted this systematic review with a rigorous methodological approach and reported the data accurately. In addition, it seems to me that the idea to build from the results a roadmap on aspects to be considered in the development of clinical protocols is useful and meets a need for clinicians involved in procedural sedation and analgesia.

WE THANK THE REVIEWER FOR THE VERY SUPPORTIVE ASSESSMENT 

I suggest only minimal revisions.

In the DISCUSSION Authors could:

explain why they suggest the use of RSS rather than UMSS for the sedation monitoring aspect;

THIS COMMENT IS WELL TAKEN AS THE MESSAGE SHOULD RATHER BE THAT A VALID SEDATION TOOL SHOULD BE USED. WE HAVE ADAPTED THIS

add considerations as to why vomiting was an AE of particular interest

WE UNDERSTAND THIS REFLECTION, BUT THIS SYMPTOM EMERGED FROM THE AVAILABLE STUDIES, LIKELY BECAUSE IT IS SUGGESTED TO BE MORE COMMON WITH CHLORAL HYDRATE; WE HAVE SOMEWHAT ADAPTED THE NARRATIVE AS THIS IS ALSO A PATIENT RELEVANT OUTCOME VARIABLE

elaborate on additional doses topic (which drug, by which route of administration).

WE HOPE THAT THE REVIEWER CAN UNDERSTAND THAT WE PREFER NOT TO TAKEN A STRONG POSITION ON THIS, AS THIS IS LIKELY DRIVEN BY LOCAL PREFERENCES AND EXPERIENCE, WHILE WE HAVE NOT RETRIEVED A CONSISTENT PRACTICE IN THE CLINICAL STUDIES RETAINED. WE HAVE ADDED THIS TO THE REVISED VERSION. 

Reviewer 2 Report

This research is under the scope of this journal; the topic is relevant to readers, and this research is about potentially significant insights in the field.

Language needs improvement, especially in the Introduction and the Discussion. One of the major concerns here is the English. The authors should have the manuscript looked at for language and sentence composition. There are a lot of sentences in the manuscript that do not make sense because of the English. 

Abstract: the authors are suggested to provide a bit more detailed information in method and result parts.

The systematic review is correctly carried out, it follows the entire process that must be carried out in a review.

I especially like it in the discussion, when it differentiates between what is statistically significant and what is clinically significant, since we often forget that what matters most is the clinic.

I would like to highlight the conclusions section, because although the final Roadmap is correct, most people will look for a section with some final conclusions.

Author Response

This research is under the scope of this journal; the topic is relevant to readers, and this research is about potentially significant insights in the field.

WE THANK THE REVIEWER FOR THE VERY SUPPORTIVE ASSESSMENT 

Language needs improvement, especially in the Introduction and the Discussion. One of the major concerns here is the English. The authors should have the manuscript looked at for language and sentence composition. There are a lot of sentences in the manuscript that do not make sense because of the English. 

WE HAVE EXPERIENCE ON PUBLICATIONS IN ENGLISH AND HAVE REASSESSED THE PAPER, WITH SPECIFIC FOCUS ON THE INTRODUCTION SECTION OF THE PAPER

Abstract: the authors are suggested to provide a bit more detailed information in method and result parts.

WE HAVE TRIED TO FURTHER ADAPT THIS, BUT THE WORD COUNT HAS ITS RESTRICTIONS

The systematic review is correctly carried out, it follows the entire process that must be carried out in a review.

THANK YOU

I especially like it in the discussion, when it differentiates between what is statistically significant and what is clinically significant, since we often forget that what matters most is the clinic.

THANK YOU

I would like to highlight the conclusions section, because although the final Roadmap is correct, most people will look for a section with some final conclusions.

WE HAVE TRIED TO FURTHER HIGHLIGHT THIS