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

Abstract

ObjectivesTo systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation.Materials and MethodsWe 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.ResultsWe 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.ConclusionsDexmedetomidine 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.

The Effectiveness of Low-dose Dexmedetomidine Infusion in Sedative Flexible Bronchoscopy: A Retrospective Analysis

“…For its high affinity to α2-adrenoceptor, low-dose infusion of dexmedetomidine may attenuate surgical stressors and offer benefits in patients at risk for cardiac morbidities [9,21]. According to one systemic literature review study, dexmedetomidine has several advantages over midazolam when used for procedural sedation, including higher patient and operator satisfaction as well as similar respiratory and hemodynamic profiles [10]. The authors suggest dexmedetomidine is a potential alternative to midazolam for procedural sedation, if carefully titrated.…”

“…It exhibits hypnotic and analgesic properties with minimal respiratory effects [9]. One systemic review study suggested dexmedetomidine exerts potential benefits over midazolam in procedural sedation [10]. However, these sedatives alone often provide insufficient sedative or analgesic effects as well as delayed recovery [11][12][13], for which previous studies suggest a combined sedative/analgesic regimen improve efficacy and safety during endoscopic examination [14][15][16].…”

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

“…The America adult ICU guideline (2013 version) proposes that the primary factor for patients' agitation is pain and discomfort, which is treated by opioids as the most basic treatment [8]. Recent researches indicate that providing "analgesic priority" treatment program can effectively improve the patient's comfort for the ICU patients [9][10][11][12]. Compared with the traditional sedative treatment, this treatment is beneficial for reducing the patient's stay in the ICU [13].…”

Awake fiberoptic nasotracheal intubation for patients with difficult airway

“…In previous studies, it was reported that midazolam (0.05–2.7 mg/kg), propofol (1.0–2.7 mg/kg) and dexmedetomidine (0.5–1.0 µg/kg) as the primary sedative agent generally describe in combination with opioid such as fentanyl (1.0–3.0 µg/kg), sufentanil (the target plasma concentration 0.3 ng/kg) or remifentanil (0.25–0.75 µg/kg) [ 5 6 7 8 9 ]. However, appropriate levels of sedation for safe awake intubation are very difficult to standardize because the required combination of anxiolysis and analgesia varies widely from case to case [ 6 10 ].…”