Maternal and neonatal outcomes with the addition of intrathecal midazolam as an adjuvant to spinal anesthesia in cesarean delivery: A systematic review and meta-analysis of randomized controlled trials

Hung, Tsung-Yu; Huang, Yin-Shan; Lin, Yun-Nan

doi:10.1016/j.jclinane.2022.110786

Cited by 8 publications

(3 citation statements)

References 46 publications

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“…A higher Modified Aldrete score demonstrates dexmedetomidine's capacity to allow easier transitions from anesthesia to alertness [45], encouraging a positive postoperative patient experience. Our study supports the use of dexmedetomidine as an adjuvant anesthesia medication for patients undergoing transsphenoidal resection of pituitary adenoma, which comes in agreement with the previous meta-analyses that recommended the usage of many adjuvant drugs, not only the dexmedetomidine, for anesthesia of different surgeries [46][47][48].…”

Section: Summary Of Findingssupporting

confidence: 91%

Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Aldosari,

Alrashid,

Alshareeda

et al. 2023

Cureus

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Dexmedetomidine has been widely studied in many surgical settings, with possible benefits in lowering anesthetic requirements, improving perioperative hemodynamic stability, and improving postoperative outcomes. This systematic review aims to evaluate the effects of dexmedetomidine in patients undergoing transsphenoidal resection of pituitary adenoma, shedding light on its potential as an adjunctive agent in anesthesia for this specific surgical population. In this review, we searched PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar from inception to July 20, 2023. A total of six randomized clinical trials (RCTs) investigating the effects of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenoma were included in this review. The outcomes of interest were extracted from the included studies as mean difference (MD) and standard deviation (SD), then analyzed using the Review Manager (RevMan, RevMan International Inc., New York, USA) software. Our literature search process retrieved 274 records. Of them, six studies were included in the meta-analysis. There was a significant difference between the dexmedetomidine group compared to the placebo group in terms of heart rate at the end of the surgery (MD = -16.5; CI = [-25.36 to -7.64]; P value = 0.0003) and after extubation (MD = -16.81; CI = [-23.18 to -10.43]; P values < 0.00001). Furthermore, dexmedetomidine significantly reduced the mean arterial blood pressure (MAP) at after both intubation and extubation (MD = -9.11 and -21.5; CI = [-13.56 to -4.65] and [-30.93 to -12.06]; P values < 0.00001). This systematic review and meta-analysis demonstrated that dexmedetomidine appears to have several potential benefits in patients undergoing transsphenoidal resection of pituitary adenoma. The use of dexmedetomidine was associated with reductions in heart rate, mean arterial blood pressure, blood loss, and duration of surgery, while showing no significant difference in propofol dose or time to extubation of the trachea.

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Section: Summary Of Findingssupporting

confidence: 91%

Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Aldosari,

Alrashid,

Alshareeda

et al. 2023

Cureus

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“…The most frequently used drug intraoperatively in the surveyed hospitals of Duhok was metoclopramide 1069 (90.0%), an antiemetic drug [23]. The use of other medications usually depends on the individual needs of each elective CS delivery case [2,4,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

Karam

Mohammad

2022

jidhealth

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Background: Limited information is available on anesthetics that are preferred or used by anesthesiologists for cesarean section (CS) delivery in Kurdistan region, Iraq. This study aims to document general or regional anesthesia use in elective CS deliveries in four major hospitals in Duhok province, Northern Iraq. Methods: A retrospective cross-sectional study was conducted from February 2019 to February 2020. The general and regional anesthetics types were recorded for each CS delivery case within the selected hospitals. Any adjuvants and medications used with the anesthetics were also recorded. Univariate and bivariate analyses were undertaken. The statistically significant was considered at less than 0.05. Results: A total of 3420 elective CS deliveries were reported. The mean age ± SD of the pregnant women was 29.6 ± 5.8 years. The anesthetics used in the four hospitals were propofol as a general anesthetic (53.0%) and bupivacaine as a spinal anesthetic (47.0%). The combination of propofol and bupivacaine was used only in 0.3%. The three most frequently and concurrently used adjuvants and medications with propofol or bupivacaine were metoclopramide (90.0%), dexamethasone (80.0%), and ephedrine (73.0%). Conclusion: Propofol and bupivacaine were the general and spinal anesthesia of choice, respectively, for elective CS delivery in Duhok province, northern Iraq. Some adjuvants and medications were supplemented to improve the quality of anesthesia and the outcome of CS delivery.

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“…Previous studies have demonstrated the effect of intrathecal midazolam in improving the quality and duration of SA. 5 Since midazolam is a widely accessible and inexpensive medication with multiple effects, we hypothesized that midazolam would prolong the anesthetic and analgesic action of intrathecal hyperbaric bupivacaine equivalent to the opioid adjuvants. Based on this assumption, we compared the efficacy of intrathecal midazolam in contrast to fentanyl and nalbuphine in hyperbaric bupivacaine in parturients undergoing elective CS.…”

Section: Introductionmentioning

confidence: 99%

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Amin

Souidan

Abdelzaam

2023

Anaesth. pain intensive care

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Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added. Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score. Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less. Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids. Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section. Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923 Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

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Maternal and neonatal outcomes with the addition of intrathecal midazolam as an adjuvant to spinal anesthesia in cesarean delivery: A systematic review and meta-analysis of randomized controlled trials

Cited by 8 publications

References 46 publications

Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

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