Dexmedetomidine versus Midazolam in Anesthetic Preoperative Administration: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Jiehao , HAN Ning ,  WU Xiuying

Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China;

Corresponding author：

WU Xiuying, Email: wuxiuying0415@163.com

Keywords：

Dexmedetomidine; Midazolam; Randomized controlled trial

DOI：

10.7507/1672-2531.20090221

Video：

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Objective 　To carry out a meta-analysis to evaluate the efficacy and safety of dexmedetomidine in comparison with midazolam as preoperative drug.
Methods 　All randomized controlled trials (RCTs) about dexmedetomidine as preoperative drug compared with midazolam were identified. Meta analysis was performed by using the statistical software RevMan 4.2.10 on the basis of strict quality evaluation.
Results 　Thirteen RCTs involving 806 patients were included. The results of meta analyses showed that dexmedetomidine was better than midazolam in decreasing perioperative blood pressure and heart rate, decreasing dosage of anesthetics, shortening of emergence time, and decreasing the occurrence of agitation, while the occurrence of perioperative hypotention and bradycardia of dexmedetomidine was much more than midazolam. The statistical outcomes showed that there were no differences between the two drugs in the satisfactory score, postoperative sedation score, the number of people needing analgesia, and occurrence of nausea and vomitting.
Conclusion 　Significant advantages in favour of dexmedetomidine as preoperative drug are observed. Dexmedetomidine is safe except for more incidences of hypotension and bradycardia.

Citation： SUN Jiehao,HAN Ning,WU Xiuying. Dexmedetomidine versus Midazolam in Anesthetic Preoperative Administration: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(11): 1231-1237. doi: 10.7507/1672-2531.20090221 Copy

1.	Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71: 108.
2.	Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54: 146.
3.	Virkkilä M, Ali-Melkkilä T, Kanto J, et al. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia, 1994, 49: 853-858.
4.	Cheung CW, Ying CLA, Chiu WK, et al. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia, 2007, 62: 1132-1138.
5.	Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth, 2006, 96: 722-726.
6.	Karaas lan K, Yi lmaz F, Gul cu N, e t al . Compar i son of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: a prospective, randomized, double-blind, clinical study. Current Therapeutic Research, 2007, 68, 69-81.
7.	Koroglu A, Demirbilek S, Teksan H, et al. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth, 2005, 94: 821-824.
8.	Schmidt AP, Valinetti EA, Bandeira D, et al. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth, 2007, 17: 667-674.
9.	Scheinin H, Jaakola ML, Sjövall S, et al . Int ramuscular dexmedetomidine as premedication for general anesthesia. A comparative multicenter study. Anesthesiology, 1993, 78: 1065-1075.
10.	Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol, 2007, 21: 25-29.
11.	Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg, 1994, 79: 646-653.
12.	Jaakko L, Marja-Leena M, Harry S. Dexmede tomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anaesthesiology, 1995, 82: 1117-1125.
13.	Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J, 2004, 97, 451-455.
14.	Aantaa R, Jaakola ML, Kal l io A, et al . A compar i son of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynaecological surgery. Br J Anaesth, 1991, 67(4): 402-409.
15.	Ustün Y, Gündüz M, Erdoğan O, et al. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg, 2006, 64(9): 1353-1358.
16.	Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
17.	Pandharipande PP, Pun BT, Herr DL, et al. Effect of Sedation with Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial. JAMA, 2007, 298: 2644-2653.
18.	Mattila MJ , Mattila ME, Olkkola KT, et al . Ef fect of dexmedetomidine and midazolam on human performance and mood. Eur J Clin Pharmacol, 1991, 41: 217-223.
19.	Angst MS, Ramaswamy B, Davies MF, et al. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology, 2004, 101: 744-752.

1. Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anaesthesia. Br J Anaesth, 1993, 71: 108.
2. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Anaesthesia, 1999, 54: 146.
3. Virkkilä M, Ali-Melkkilä T, Kanto J, et al. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia, 1994, 49: 853-858.
4. Cheung CW, Ying CLA, Chiu WK, et al. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia, 2007, 62: 1132-1138.
5. Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth, 2006, 96: 722-726.
6. Karaas lan K, Yi lmaz F, Gul cu N, e t al . Compar i son of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: a prospective, randomized, double-blind, clinical study. Current Therapeutic Research, 2007, 68, 69-81.
7. Koroglu A, Demirbilek S, Teksan H, et al. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth, 2005, 94: 821-824.
8. Schmidt AP, Valinetti EA, Bandeira D, et al. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatr Anesth, 2007, 17: 667-674.
9. Scheinin H, Jaakola ML, Sjövall S, et al . Int ramuscular dexmedetomidine as premedication for general anesthesia. A comparative multicenter study. Anesthesiology, 1993, 78: 1065-1075.
10. Demiraran Y, Korkut E, Tamer A, et al. The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study. Can J Gastroenterol, 2007, 21: 25-29.
11. Erkola O, Korttila K, Aho M, et al. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg, 1994, 79: 646-653.
12. Jaakko L, Marja-Leena M, Harry S. Dexmede tomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anaesthesiology, 1995, 82: 1117-1125.
13. Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J, 2004, 97, 451-455.
14. Aantaa R, Jaakola ML, Kal l io A, et al . A compar i son of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynaecological surgery. Br J Anaesth, 1991, 67(4): 402-409.
15. Ustün Y, Gündüz M, Erdoğan O, et al. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg, 2006, 64(9): 1353-1358.
16. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology, 2000, 93(2): 382-394.
17. Pandharipande PP, Pun BT, Herr DL, et al. Effect of Sedation with Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients: The MENDS Randomized Controlled Trial. JAMA, 2007, 298: 2644-2653.
18. Mattila MJ , Mattila ME, Olkkola KT, et al . Ef fect of dexmedetomidine and midazolam on human performance and mood. Eur J Clin Pharmacol, 1991, 41: 217-223.
19. Angst MS, Ramaswamy B, Davies MF, et al. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology, 2004, 101: 744-752.

Chinese Journal of Evidence-Based Medicine

Dexmedetomidine versus Midazolam in Anesthetic Preoperative Administration: A Meta-analysis

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