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Is dexmedetomidine superior to midazolam as a premedication in children? A meta‐analysis of randomized controlled trials
Author(s) -
Sun Yu,
Lu Yi,
Huang Yan,
Jiang Hong
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12391
Subject(s) - dexmedetomidine , premedication , medicine , midazolam , sedation , anesthesia , randomized controlled trial , cochrane library , sedative , meta analysis , confidence interval , relative risk , prospective cohort study , surgery
Summary Background In the current published literature, there are controversial results regarding the effectiveness of dexmedetomidine compared with midazolam as premedication in children. The aim of this meta‐analysis was to compare the use of dexmedetomidine as a premedication in pediatric patients with that of midazolam. Methods We searched for articles published in English that matched the key words ‘dexmedetomidine’, ‘midazolam’, and ‘children’ in the PubMed, Cochrane Library, Ovid, and Google Scholar databases. Additional studies were identified from the reference lists of the retrieved articles. Only prospective randomized controlled trials ( RCT s) that compared the use of dexmedetomidine and midazolam as premedications in children were included. The extraction of data from the articles was performed independently by two authors using a predesigned Excel spreadsheet. The relative risks ( RR s), weighted mean differences ( WMD s), and their corresponding 95% confidence intervals (95% CI s) were calculated for dichotomous and continuous outcome data using the quality effects model of the Meta XL version 1.3 software. Results Eleven prospective RCT s (829 children) met our criteria. Compared with midazolam, dexmedetomidine premedication was associated with more satisfactory sedation upon parent separation (eight RCT s [679 children]; RR : 1.25; 95% CI : 1.06, 1.46) and upon mask acceptance (seven RCT s [559 children]; RR : 1.17; 95% CI : 1.01, 1.36). During the postoperative period, premedication with dexmedetomidine lowered the numbers of requests for rescue analgesia (six RCT s [477 children]; RR : 0.55; 95% CI : 0.40, 0.74) and lowered the risks of agitation or delirium (seven RCT s with [466 children]; RR : 0.59; 95% CI : 0.40, 0.88), and shivering (three RCT s [192 children]; RR : 0.33; 95% CI : 0.18, 0.61). However, dexmedetomidine premedication reduced systolic blood pressure (three RCT s [242 children]; WMD : −11.47 mm·Hg −1 ; 95% CI : −13.95, −8.98), mean blood pressure (three RCT s [202 children]; WMD : −5.66 mm·Hg −1 ; 95% CI : −8.89, −2.43), and heart rate (six RCT s [444 children]; WMD : −12.71 beat·min −1 ; 95% CI : −14.80, −10.62), and prolonged the onset of sedation (two RCT s [132 children] WMD : 13.78 min; 95% CI : 11.33, 16.23; I 2 = 0%) relative to midazolam. Conclusion This meta‐analysis demonstrated that dexmedetomidine premedication is superior to midazolam premedication in terms of producing satisfactory sedation upon parent separation and mask acceptance. Dexmedetomidine premedication provides clinical benefits that included reducing the requirements for rescue analgesia and reducing agitation or delirium and shivering during the postoperative period. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with dexmedetomidine should be considered.