Baptista, Lidia SofiaPelicano Paulos, JorgePinto Carneiro, Ana2025-08-272025-08-272024-12Cureus . 2024 Dec 18;16(12):e75959.39698201http://hdl.handle.net/10400.17/5151Managing sedation in pediatric patients with complex facial anomalies and airway challenges requires careful consideration of safety and efficacy. This case report presents the use of the Ketodex sedation protocol, combining ketamine (NMDA receptor antagonist) and dexmedetomidine (alpha-2-agonist), for a child with a large cervical/facial mass undergoing a diagnostic magnetic resonance imaging (MRI). Ketodex provides effective sedation with minimal need for manipulation of the airway and side effects, making it ideal for cases involving difficult airways. Our protocol allows spontaneous ventilation without compromising airway reflexes and reduces airway hyperreactivity, ensuring safety in high-risk pediatric cases. Initiating sedation in a controlled environment enhances safety before moving to remote locations. The Ketodex protocol is a safe and effective choice for managing pediatric patients with challenging airways. Its use should be prioritized in controlled settings, with adaptations for individual patient needs.endexmedetomidinedifficult airwayketaminepediatric anesthesiasafetysedationHDE ANStext10.7759/cureus.75959