A comparative evaluation of dexmedetomidine and midazolam in pediatric sedation: A meta‐analysis of randomized controlled trials with trial sequential analysis

Abstract

Background The present study with trial sequential analysis (TSA) was conducted to evaluate comprehensively the efficacy and safety of dexmedetomidine and midazolam in pediatric sedation, and to investigate whether the outcomes achieved the required information size to draw the conclusions. Methods PubMed, Embase, and Cochrane Library were searched from inception to October 2019. All randomized controlled trials used dexmedetomidine and midazolam in pediatric sedation were enrolled. Sedative efficacy, postoperative analgesic effect, and incidence of emergence agitation were considered as the co‐primary outcomes. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to rate the quality of evidences. Results We acquired data from 34 studies involving 2281 pediatric patients. The results indicated that administration of dexmedetomidine was associated with less incidence of emergence agitation (RR = 0.78, with 95% CI [0.65, 0.92]) and more satisfactory sedation at parental separation (RR = 0.31, with 95% CI [0.24, 0.41]) compared to midazolam, and the current sample sizes were sufficient with unnecessary further trials. Two groups did not differ significantly in sedation level at mask induction (RR = 0.86, with 95% CI [0.74, 1.00]). And using of dexmedetomidine was associated with less incidence of postoperative analgesic rescue (RR = 0.57, with 95% CI [0.35, 0.93]), but the number of patients was too few to achieve the required information size and to draw reliable conclusions. Premedication of dexmedetomidine was associated with significant less value of SBP, heart rate, increased incidence of bradycardia, and a lower rate of shivering. And there were no differences about onset of sedation and recovery time between two groups. Conclusions Given that more satisfactory sedation at separation from parents and less incidence of emergence agitation, dexmedetomidine is preferred for pediatric sedation. However, compared with midazolam, the superiority of dexmedetomidine in providing adequate sedation at mask induction and postoperative analgesic effects has not yet been defined.

Effect of different administration and dosage of dexmedetomidine in the reduction of emergence agitation in children: a meta-analysis of randomized controlled trials with sequential trial analysis

“…Our meta-analysis suggested that DEX was superior to midazolam for preventing EA in children, in line with the findings of Lang et al (89) and Rao et al (13). TSA and GRADE results revealed that the level of evidence about the DEX's superiority over midazolam in reducing EA incidence was sufficient.…”

Development and validation of prediction models for neurocognitive disorders in adult patients admitted to the ICU with sleep disturbance

“…29,30 However, the impact of midazolam, the most powerful predictor, is changeable owing to the use of low-risk sedatives, such as dexmedetomidine and propofol as substitutes. 12,31,32 Dexmedetomidine was not significantly associated with NCDs in this cohort and even appeared to provide potential protection against delirium among adults on mechanical ventilators. 12,33 Besides, the targeted sedation level of dexmedetomidine was not different from that of midazolam in ICU patients; dexmedetomidine-treated patients experienced less delirium.…”

A Comprehensive Evaluation Between Dexmedetomidine and Midazolam for Intraoperative Sedation in the Elderly: Protocol for a Systematic Review and Meta-analysis of Randomized Controlled Trials

“…have not yet reached a reliable and consistent conclusion in the sedation of elderly patients. Although a metaanalysis related to anesthesia in children has con rmed that Dexmedetomidine is safer and more effective than Midazolam in terms of sedation and reduction of postoperative complications [23][24][25]. However, there still lacks comparison on the safety and e cacy between Dexmedetomidine and Midazolam in elderly surgery due to signi cant heterogeneities between the clinical RCTs, resulting in inconsistent and controversial conclusions.…”