Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety

Clemens R M Barends, Anthony Absalom, Baucke van Minnen, Arjan Vissink, Anita Visser, Clemens R M Barends, Anthony Absalom, Baucke van Minnen, Arjan Vissink, Anita Visser

Abstract

Objectives: To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation.

Materials and methods: We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications.

Results: We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar.

Conclusions: Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA Diagram.
Fig 1. PRISMA Diagram.

References

    1. Miller RD. Miller's Anesthesia. Philadelphia, Pa.; Edinburgh: Elsevier Saunders; 2009.
    1. Lodenius A, Ebberyd A, Hardemark Cedborg A, Hagel E, Mkrtchian S, Christensson E, et al. Sedation with Dexmedetomidine or Propofol Impairs Hypoxic Control of Breathing in Healthy Male Volunteers: A Nonblinded, Randomized Crossover Study. Anesthesiology. 2016;125: 700–715. 10.1097/ALN.0000000000001236
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17: 1–12.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6: e1000097 10.1371/journal.pmed.1000097
    1. Frolich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of midazolam, propofol, and dexmedetomidine in healthy volunteers. J Clin Anesth. 2011;23: 218–223. 10.1016/j.jclinane.2010.09.006
    1. Frolich MA, Zhang K, Ness TJ. Effect of sedation on pain perception. Anesthesiology. 2013;118: 611–621. 10.1097/ALN.0b013e318281592d
    1. Alhashemi JA. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. Br J Anaesth. 2006;96: 722–726. 10.1093/bja/ael080
    1. Apan A, Doganci N, Ergan A, Buyukkocak U. Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery. Minerva Anestesiol. 2009;75: 239–244.
    1. Cheung CW, Ying CL, Chiu WK, Wong GT, Ng KF, Irwin MG. A comparison of dexmedetomidine and midazolam for sedation in third molar surgery. Anaesthesia. 2007;62: 1132–1138. 10.1111/j.1365-2044.2007.05230.x
    1. Demiraran Y, Korkut E, Tamer A, Yorulmaz I, Kocaman B, Sezen G, 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.
    1. Fan TW, Ti LK, Islam I. Comparison of dexmedetomidine and midazolam for conscious sedation in dental surgery monitored by bispectral index. Br J Oral Maxillofac Surg. 2013;51: 428–433. 10.1016/j.bjoms.2012.08.013
    1. Hashiguchi K, Matsunaga H, Higuchi H, Miura S. Dexmedetomidine for sedation during upper gastrointestinal endoscopy. Dig Endosc. 2008;20: 178–183.
    1. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anaesth. 2010;57: 39–45. 10.1007/s12630-009-9231-6
    1. Liao W, Ma G, Su QG, Fang Y, Gu BC, Zou XM. Dexmedetomidine versus midazolam for conscious sedation in postoperative patients undergoing flexible bronchoscopy: a randomized study. J Int Med Res. 2012;40: 1371–1380.
    1. Muttu S, Liu EH, Ang SB, Chew PT, Lee TL, Ti LK. Comparison of dexmedetomidine and midazolam sedation for cataract surgery under topical anesthesia. J Cataract Refract Surg. 2005;31: 1845–1846.
    1. Ustun Y, Gunduz M, Erdogan O, Benlidayi ME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg. 2006;64: 1353–1358. 10.1016/j.joms.2006.05.020
    1. Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to benzodiazepines: literature review and treatment options. Pharmacotherapy. 2004;24: 1177–1185.
    1. Wu XH, Cui F, Zhang C, Meng ZT, Wang DX, Ma J, et al. Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: A Pilot Randomized Controlled Trial. Anesthesiology. 2016.
    1. Alexopoulou C, Kondili E, Diamantaki E, Psarologakis C, Kokkini S, Bolaki M, et al. Effects of dexmedetomidine on sleep quality in critically ill patients: a pilot study. Anesthesiology. 2014;121: 801–807. 10.1097/ALN.0000000000000361
    1. Somma J, Donner A, Zomorodi K, Sladen R, Ramsay J, Geller E, et al. Population pharmacodynamics of midazolam administered by target controlled infusion in SICU patients after CABG surgery. Anesthesiology. 1998;89: 1430–1443.
    1. Zomorodi K, Donner A, Somma J, Barr J, Sladen R, Ramsay J, et al. Population pharmacokinetics of midazolam administered by target controlled infusion for sedation following coronary artery bypass grafting. Anesthesiology. 1998;89: 1418–1429.
    1. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93: 382–394.
    1. Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67: 825–831. 10.1007/s00228-011-1002-y
    1. Zhang X, Bai X, Zhang Q, Wang X, Lu L. The safety and efficacy of intranasal dexmedetomidine during electrochemotherapy for facial vascular malformation: a double-blind, randomized clinical trial. J Oral Maxillofac Surg. 2013;71: 1835–1842. 10.1016/j.joms.2013.06.202
    1. Nooh N, Sheta SA, Abdullah WA, Abdelhalim AA. Intranasal atomized dexmedetomidine for sedation during third molar extraction. Int J Oral Maxillofac Surg. 2013;42: 857–862. 10.1016/j.ijom.2013.02.003
    1. Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir