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)