Shenzhen Children's Hospital, Shenzhen, 518026, China.
Department of Pediatric Dentistry, Sichuan Hospital of Stomatology, Chengdu, 61000, China.
BMC Anesthesiol. 2024 Jun 21;24(1):210. doi: 10.1186/s12871-024-02570-1.
Dexmedetomidine and midazolam are commonly used sedatives in children. We conducted a systematic review and meta-analysis to compare the safety and effectiveness of sedation provided by dexmedetomidine combined with midazolam versus other sedatives including chloral hydrate, midazolam and other sedatives in pediatric sedation.
The Embase, Web of Science, Cochrane Library, and PubMed databases, and Clinicaltrials.gov register of controlled trials were searched from inception to June 2022. All randomized controlled trials used dexmedetomidine-midazolam in pediatric sedation were enrolled. The articles search, data extraction, and quality assessment of included studies were performed independently by two researchers. The success rate of sedation was considered as the primary outcome. The secondary outcomes included onset time of sedation, recovery time of sedation and occurrence of adverse events.
A total of 522 studies were screened and 6 RCTs were identified; 859 patients were analyzed. The administration of dexmedetomidine combined with midazolam was associated with a higher sedation success rate and a lower incidence of nausea and vomiting in computed tomography, magnetic resonance imaging, Auditory Brainstem Response test or fiberoptic bronchoscopy examinations than the other sedatives did (OR = 2.92; 95% CI: 1.39-6.13, P = 0.005, I = 51%; OR = 0.23, 95% CI: 0.07-0.68, P = 0.008, I = 0%, respectively). Two groups did not differ significantly in recovery time and the occurrence of adverse reactions (WMD = - 0.27, 95% CI: - 0.93 to - 0.39, P = 0.42; OR 0.70; 95% CI: 0.48-1.02, P = 0.06, I = 45%. respectively). However, the results of the subgroup analysis of ASA I-II children showed a quicker onset time in dexmedetomidine-midazolam group than the other sedatives (WMD=-3.08; 95% CI: -4.66 to - 1.49, P = 0.0001, I = 30%).
This meta-analysis showed that compared with the control group, dexmedetomidine combined with midazolam group provided higher sedation success rates and caused a lower incidence of nausea and vomiting in completing examinations, indicating a prospective outpatient clinical application for procedural sedation.
右美托咪定和咪达唑仑是儿童中常用的镇静剂。我们进行了一项系统评价和荟萃分析，以比较右美托咪定联合咪达唑仑与氯醛、咪达唑仑和其他镇静剂在儿科镇静中的安全性和有效性。
从成立到 2022 年 6 月，我们检索了 Embase、Web of Science、Cochrane 图书馆和 PubMed 数据库以及临床试验.gov 对照试验注册处。所有使用右美托咪定-咪达唑仑进行儿科镇静的随机对照试验均被纳入。由两名研究人员独立进行文章检索、数据提取和纳入研究的质量评估。镇静成功率被认为是主要结局。次要结局包括镇静起效时间、镇静恢复时间和不良反应发生情况。
共筛选出 522 项研究，确定了 6 项 RCT，分析了 859 例患者。与其他镇静剂相比，右美托咪定联合咪达唑仑用于 CT、磁共振成像、听觉脑干反应测试或纤维支气管镜检查时，镇静成功率更高，恶心和呕吐发生率更低（OR=2.92；95%CI：1.39-6.13，P=0.005，I=51%；OR=0.23，95%CI：0.07-0.68，P=0.008，I=0%）。两组在恢复时间和不良反应发生率方面无显著差异（WMD=-0.27，95%CI：-0.93 至-0.39，P=0.42；OR 0.70；95%CI：0.48-1.02，P=0.06，I=45%）。然而，ASA I-II 儿童亚组分析的结果显示，右美托咪定-咪达唑仑组的起效时间快于其他镇静剂（WMD=-3.08；95%CI：-4.66 至-1.49，P=0.0001，I=30%）。
本荟萃分析表明，与对照组相比，右美托咪定联合咪达唑仑组在完成检查时提供了更高的镇静成功率，且恶心和呕吐的发生率更低，这表明该方法在门诊程序镇静中有一定的应用前景。
