Safety & Efficacy of Intranasal Dexmedetomidine, Fentanyl & Midazolam in the Pediatric Emergency Room

Inclusion Criteria: * Primary complaint of "laceration" * 2 years to 6 years of age (inclusive) * Initial presentation at the Arkansas Children's Hospital (ACH) Emergency Department Exclusion Criteria: * Prior allergic reaction to fentanyl or midazolam or dexmedetomidine * Prior major adverse reaction to fentanyl or midazolam (e.g. seizure-like activity, paradoxical reaction, hallucinations) * Nasal injury/deformity * Potential for altered pain perception (e.g. autism, severe sensory-neural disturbances) * History of adverse reaction to sedation/anesthesia * History of cardiac arrhythmia * History of liver dysfunction * Concurrent injuries that would necessitate higher levels of care (e.g. inpatient admission, immediate evaluation in the operating room (OR), etc.) * Complex (multi-layer) lacerations or those requiring subspecialty consultation for repair * American Society of Anesthesiology (ASA) score ≥ 3 * Use of analgesics (with the exception of ibuprofen or acetaminophen) or anxiolytics in the immediate pre-examination period (within 4 hours)