A systematic review and meta-analysis of propofol versus midazolam sedation in adult intensive care (ICU) patients

Garcia, Raphaela; Salluh, Jorge I.; Andrade, Teresa Raquel; Farah, Daniela; Silva, Paulo S. L. da; Bastos, D.F.; Fonseca, Marcelo Cunio Machado

doi:10.1016/j.jcrc.2021.04.001

Cited by 28 publications

(24 citation statements)

References 54 publications

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“…[ 18 ] As reported by Andersen et al .’s study, entitled “A systematic review of perioperative melatonin,” melatonin reduces anxiety and pain scores compared with placebo. [ 11 ] Their results were in line with ours.…”

Section: Discussionsupporting

confidence: 90%

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The pain control efficacy of zolpidem versus melatonin after intervertebral disc herniation surgery under general anaesthesia: A randomised clinical trial

Moshiri

Modir

Mohammadi

et al. 2022

J West Afr Coll Surg

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Background: Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias. Objectives: The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia. Materials and Methods: Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp). Results: Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores ( P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events. Conclusion: The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.

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Section: Discussionsupporting

confidence: 90%

“…[ 9 ] To our knowledge, melatonin is associated with many receptors: opioidergic, benzodiazepinergic, muscarinic, nicotinic, serotonergic, α1- and α2-adrenergic, and melatonergic receptors in the spinal cord of the central nervous system. [ 10 11 ]…”

Section: Introductionmentioning

confidence: 99%

The pain control efficacy of zolpidem versus melatonin after intervertebral disc herniation surgery under general anaesthesia: A randomised clinical trial

Moshiri

Modir

Mohammadi

et al. 2022

J West Afr Coll Surg

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“…Midazolam is a benzodiazepine sedative, which is commonly used in clinical anesthesia and intensive care unit (ICU) (Lazzaroni and Bianchi Porro, 2003;Garcia et al, 2021). Clinical research shows that the sedation of critical patients with midazolam 48 h continuous infusion can significantly reduce the level of IL-1β, IL-6 and TNF-α in blood (Helmy and Al-Attiyah, 2001).…”

Section: Discussionmentioning

confidence: 99%

Midazolam Ameliorates Acute Liver Injury Induced by Carbon Tetrachloride via Enhancing Nrf2 Signaling Pathway

et al. 2022

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Oxidative stress contributes greatly to initiation and progression of liver injury. Activation of nuclear-factor erythroid 2-related factor 2 (Nrf2) has been considered as an attractive strategy for preventing and treating the oxidative damage related to liver injury. This study aimed to find an efficacious agent to activate Nrf2/HO-1 signaling pathway from clinically used therapeutic agents and to characterize the usefulness for preventing and treating CCl4-induced acute liver injury. For this purpose, a series of clinically used therapeutic agents were collected and their activation potentials on Nrf2 were assayed by using 293T-Nrf2-luc cell line. Among all tested therapeutic agents, midazolam was found with good Nrf2 activation effect and this agent could significantly ameliorate CCl4-induced damage to HepG2 cells. In vivo animal tests showed that pretreatment with midazolam reduced the liver pathological tissue damage and the serum levels of ALT and AST in CCl4-induced liver injury mice. Further investigations showed that midazolam could strongly up-regulate the expression of both Nrf2 and HO-1 in the mice liver, accompanied by increasing of the levels of antioxidant enzyme SOD and reducing the production of MDA, as well as reducing the pro-inflammatory cytokines (IL-6, TNF-α) secretion. Collectively, our results clearly demonstrate that midazolam can ameliorate CCl4-induced acute liver injury and oxidative stress via activating the Nrf2 signaling pathway.

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“…Many studies have shown that, compared with midazolam, the prognosis of severely ill patients treated with propofol is better, including the duration of mechanical ventilation and tracheal removal in the ICU. Tube time is shorter (21,22), and propofol is associated with lower medical costs (23). This study included real-world cases with a large sample size, but the results were inconsistent with previous studies.…”

Section: Discussionmentioning

confidence: 86%

The effects of midazolam or propofol plus fentanyl on ICU mortality: a retrospective study based on the MIMIC-IV database

Sun¹,

Yan²,

Hu³

et al. 2022

Ann Transl Med

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Background: Patients in the intensive care unit (ICU) are often under stress and fail to cooperate well with invasive treatments. Analgesia and sedation are of great significance for reducing the suffering of patients and ensuring the application and effectiveness of treatment. For better clinical choice, we aimed to explore the effect of the combination of propofol + fentanyl or midazolam + fentanyl on the short-term prognosis of hospitalized patients in the ICU.Methods: According to the inclusion and exclusion criteria, we retrospectively included patients in the MIMIC-IV database receiving midazolam + fentanyl or propofol + fentanyl analgesic and sedative treatment using Structured Query Language (SQL) to extract clinical data from the MIMIC-IV database. The primary endpoint was the death rate within 28 days after the patient was admitted to the ICU. Doubly robust estimation was used to infer the relationship between sedation and analgesia and 28 days outcome. The gradient boosted model (GBM) was used to estimate the propensity score (PS) of the patient's sedation and analgesia program, PS was used as the weight, and the inverse probabilities weighting (IPW) model was used to generate a weighted cohort.Results: In total, 4,188 cases were included, with 2,174 (51.9%) in the propofol group and 2,014 (48.1%) in the midazolam group. In the PS score matching cohort, the 28-day mortality of patients in the midazolam group was 30.8%, and the 28-day mortality of patients in the propofol group was 25.5%. The adjusted odds ratio (OR) value was 1.421 [95% confidence interval (CI): 1.118-1.806, P<0.001]. Patients in the propofol group did not use vasoactive drugs for a longer period of time than the midazolam group, and patients in the propofol group received significantly more fluids than those in the midazolam group in the first three days after admission to the ICU.Conclusions: Compared with midazolam combined with fentanyl, propofol combined with fentanyl for sedation and analgesia can reduce the risk of short-term death in ICU patients.

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A systematic review and meta-analysis of propofol versus midazolam sedation in adult intensive care (ICU) patients

Cited by 28 publications

References 54 publications

The pain control efficacy of zolpidem versus melatonin after intervertebral disc herniation surgery under general anaesthesia: A randomised clinical trial

The pain control efficacy of zolpidem versus melatonin after intervertebral disc herniation surgery under general anaesthesia: A randomised clinical trial

Midazolam Ameliorates Acute Liver Injury Induced by Carbon Tetrachloride via Enhancing Nrf2 Signaling Pathway

The effects of midazolam or propofol plus fentanyl on ICU mortality: a retrospective study based on the MIMIC-IV database

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