Comparative Analysis of Sedative Efficacy of Dexmedetomidine and Midazolam in Pediatric Dental Practice: A Systematic Review and Meta-Analysis

Abstract

Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the pre-operative phase could cause the dentist to have issues with behavior control. Additionally, it may make pediatric dental treatments less effective. In order to reduce anxiety and control behavior in children receiving dental care, sedation is a pharmacological management technique that supports the provision of effective and high-quality dental services. The aim is to compare and evaluate the efficacy of sedative agents like dexmedetomidine and midazolam in pediatric dental practice. A thorough review of the literature was conducted using electronic databases like “MEDLINE, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as the World Health Organization International Clinical Trials Registry Platform, www.clinicaltrials.gov , conference proceedings abstracts, a bibliography of pertinent references, and manual searches of journals, conferences, and books”. There were no restrictions on the language or the date of publication when searching the electronic databases. Randomized controlled trials were included which compared dexmedetomidine and midazolam in children up to 16 years of age subjected to dental treatment. Information on procedures, participants, interventions, outcome measures, and results were independently extracted by three review writers (TS, SL, and RO). Trial authors were contacted for papers that were confusing or lacking information. The risk of bias was evaluated for each study. We adhered to the Cochrane statistical recommendations. Three trials totaling 229 participants were included. All three studies were rated as having a low risk of bias, with none of them having a high or unclear risk. Meta-analysis was done for the available data for the primary outcomes like sedation level and recovery time. We searched for randomized controlled trials up to Jan 31, 2020. Participants are randomly assigned to an intervention or control group in randomized controlled trial research. While patients in the control group often get a placebo therapy or procedure, those in the interventional group receive the treatment being studied. We found three studies eligible to include in the review. One study evaluated 73 individuals who received general anesthesia for dental treatment. There were 72 and 84 individuals in the second and third investigations, respectively. All the participants of the three studies were divided randomly into two groups and were subjected to dexmedetomidine and midazolam as sedative agents. We gave the evidence an "extremely low certainty" rating. Because there are just three short trials with unusual parameters for comparison, the results are questionable. Overall, the results do not allow us to draw any firm conclusions. Three randomized controlled trials included in this systematic review reported data with varying conclusions; hence we recom...

Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

“…In addition, it comes in agreement with the previous meta-analyses that showed the beneficial effects of dexmedetomidine in different types of surgeries [35][36][37][38][39][40][49][50][51]. Moreover, a previous meta-analysis conducted by Liu et al [52] evaluating the efficacy and safety of dexmedetomidine in patients who had undergone transsphenoidal surgical resection of pituitary adenoma, including four randomized controlled trials with a total of 160 patients showed that the dexmedetomidine significantly reduced mean arterial pressure and heart rate at 30 minutes, blood loss and fentanyl usage.…”

“…Our study supports the use of dexmedetomidine as an adjuvant anesthesia medication for patients undergoing transsphenoidal resection of pituitary adenoma, which comes in agreement with the previous meta-analyses that recommended the usage of many adjuvant drugs, not only the dexmedetomidine, for anesthesia of different surgeries [ 46 - 48 ]. In addition, it comes in agreement with the previous meta-analyses that showed the beneficial effects of dexmedetomidine in different types of surgeries [ 35 - 40 , 49 - 51 ]. Moreover, a previous meta-analysis conducted by Liu et al [ 52 ] evaluating the efficacy and safety of dexmedetomidine in patients who had undergone transsphenoidal surgical resection of pituitary adenoma, including four randomized controlled trials with a total of 160 patients showed that the dexmedetomidine significantly reduced mean arterial pressure and heart rate at 30 minutes, blood loss and fentanyl usage.…”

“…As a result of better surgical circumstances and a more expeditious technique, this can result in shorter operating times. Dexmedetomidine's sedative impact is consistent with its known characteristics and with results from other surgical procedures [35][36][37][38] where it has been demonstrated to improve patient comfort and surgeon satisfaction [39,40].…”

Clinical efficacy of titanium prepared platelet rich fibrin in periodontal regeneration: A systematic review and meta-analysis

“…Any language restrictions in the study selection process were not taken into consideration as a constraint for carrying out this evaluation. The complete review includes a PRISMA flow chart 32 that shows the precise status of all identified studies in accordance with the recommendation found in "Part 2, Section 11.2.1 of the Cochrane Guidelines for Systematic Reviews of Interventions". 24 Irrespective of the reporting of outcome data, studies were included in this review as shown in Figure 1.…”

“…https://doi.org/10.6084/m9.figshare.22341559.v1. 32 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).…”