Differences in efficacy and safety of midazolam vs. dexmedetomidine in critically ill patients: A meta‑analysis of randomized controlled trial

Zhou, Wenjun; Liu, Mei; Fan, Xiaolin

doi:10.3892/etm.2020.9297

Cited by 7 publications

(7 citation statements)

References 31 publications

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“…Because of the low level of evidence, international guidelines issued only a conditional recommendation [3,14]. Some previous analysis suggested that dexmedetomidine provided an advantage over midazolam in terms of shorter sedation duration and fewer adverse events over midazolam, the low quality of inclusion articles [15] or few outcome measures [16] prompted us to update our analysis. In addition, although previous studies confirmed that dexmedetomidine was superior to benzodiazepines for mechanical ventilation in the ICU [17,18], these previous researches included studies comparing dexmedetomidine to lorazepam.…”

Section: Introductionmentioning

confidence: 99%

A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis

Wen,

Ding,

Liu

et al. 2023

PLoS ONE

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Background The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion. Methods An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed. Results 16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p<0.0001), lower risk of delirium (RR = 0.63, 95%CI = 0.50, 0.81, p = 0.0002), and shorter duration of mechanical ventilation (MD = -0.83, 95%CI = -1.24, -0.43, p<0.0001). The association between dexmedetomidine and bradycardia was also found to be significant (RR 2.21, 95%CI 1.31, 3.73, p = 0.003). We found no difference in hypotension (RR = 1.44, 95%CI = 0.87, 2.38, P = 0.16), mortality (RR = 1.02, 95%CI = 0.83, 1.25, P = 0.87), neither in terms of adverse effects requiring intervention, hospital length of stay, or sedation effects. Conclusions Combined with recent evidence, compared with midazolam, dexmedetomidine decreased the risk of delirium, mechanical ventilation, length of stay in the ICU, as well as reduced patient costs. But dexmedetomidine could not reduce mortality and increased the risk of bradycardia.

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Section: Introductionmentioning

confidence: 99%

A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis

Wen,

Ding,

Liu

et al. 2023

PLoS ONE

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“…In their meta-analysis, W.-J. Zhou et al (2021) compared the efficacy and safety of midazolam (MDZ) and dexmedetomidine (DEX) in critically ill patients. Dexmedetomidine, a highly selective central alpha-2 adrenergic agonist, is known for its mild sedation, analgesia, and sleep-inducing properties, with the added benefit of reducing the incidence of delirium and promoting earlier extubation and discharge from the ICU.…”

Section: Compared Effectiveness Safety and Cost Of Dexmedetomidine Wi...mentioning

confidence: 99%

“…Based on Zhou's study it was reported that the difference in length of stay in the ICU in patients who received dexmedetomidine and Midazolam was very significant (W.-J. Zhou et al, 2021). Patients receiving midazolam spent longer in the ICU (10 days) compared to patients receiving dexmedetomidine (7 days).…”

Section: Effectivenessmentioning

confidence: 99%

Compared Effectiveness, Safety and Cost of Dexmedetomidine With Midazolam: A Review

Rahayu,

Mutripah

2023

COMORBID

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Dexmedetomidine, an alpha 2 receptor agonist sedative drug, has recently garnered attention as a viable alternative to midazolam, a widely used benzodiazepine for sedation in adult patients. The aim of this study was to conduct a comprehensive comparison of the clinical sedative efficacy, cost-effectiveness, and safety profiles of dexmedetomidine versus midazolam, utilizing a randomized controlled trial design. The search encompassed several databases, including PubMed, Scopus, Web of Knowledge, CINAHL, the United States National Library of Medicine, and Google Scholar for Systematic Reviews, using the keywords 'dexmedetomidine,' 'midazolam,' and 'effectiveness.' The findings revealed that dexmedetomidine demonstrated a more favorable safety profile, with a lower incidence of delirium compared to midazolam. In terms of effectiveness, no significant differences were observed between the two drugs for local sedation. Notably, adult patients treated with dexmedetomidine had a shorter Intensive Care Unit (ICU) stay (7 days) compared to those receiving midazolam (10 days). Similarly, pediatric ICU treatment indicated a shorter duration with dexmedetomidine (20 hours) as opposed to midazolam (38 hours). Regarding cost-effectiveness, dexmedetomidine emerged as a cost-saving option, being approximately 10% cheaper than midazolam for adult ICU patients. These findings collectively highlight the advantages of dexmedetomidine over midazolam, encompassing superior safety, effectiveness, and cost-efficiency, thus providing valuable insights for healthcare practitioners and decision-makers.

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“…There was no difference in the incidence of hypotension between the usage of these two agents however, incidence of bradycardia was greater in the dexmedetomidine group. 12 Dexmedetomidine has also been highlighted as an agent to mitigate agitation to reduce the failure of non-invasive ventilation in critically ill patients. Dexmedetomidine is not associated with ventilatory impairment, an unwanted side-effect of other sedative agents currently in use.…”

Section: Role As a Sedative For Adult Patientsmentioning

confidence: 99%

Use of Dexmedetomidine for Anesthesia and Pain Management

Nazir¹,

Khan²

2022

Anaesth. pain intensive care

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Background & objective: Since 1999, dexmedetomidine has been used in several patient populations after its approval as a sedative by the FDA. Subsequently, a large number of clinical trials on its benefits have been published widely in the literature. This review aims to update readers regarding recent evidence for approved as well as novel uses of dexmedetomidine and identify future areas of clinical research involving this relatively new drug. Sources: Randomized controlled trials conducted between January 2000 and August 2021, which compared dexmedetomidine with other sedative agents used in adult and pediatric patients undergoing mechanical ventilation in ICU, bronchoscopy and endoscopic procedures, general and locoregional anesthesia and chronic pain management were included in this review of the literature. PubMed, Science Direct, the Cochrane library and Google Scholar were used as databases. Implications: Dexmedetomidine is a multipurpose drug that has found unparalleled utility in intensive care medicine and anesthesiology. Its various advantages over traditional sedative agents have been documented, including decreased duration of mechanical ventilation, decreased incidence of delirium, perioperative analgesia and organ protective properties. Recently there has been mounting interest in dexmedetomidine as an analgesic adjunct in chronic and cancer pain management. However, there is still a paucity of well controlled studies evaluating the use of dexmedetomidine outside of a traditional sedative/analgesic role. The future direction of the research may focus on long term clinical benefits of dexmedetomidine in certain perioperative populations and its non-conventional use in palliative care and pain medicine. Citation: Ahmed WN, Khan AW. Use of dexmedetomidine for anesthesia and pain management: an updated review of literature. Anaesth. pain intensive care 2022;26(5):702-709; DOI: 10.35975/apic.v26i5.2020

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Differences in efficacy and safety of midazolam vs. dexmedetomidine in critically ill patients: A meta‑analysis of randomized controlled trial

Cited by 7 publications

References 31 publications

A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis

A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis

Compared Effectiveness, Safety and Cost of Dexmedetomidine With Midazolam: A Review

Use of Dexmedetomidine for Anesthesia and Pain Management

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