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.
Highlights
Procedural sedation can provide more comfort for the patient and an easier procedure for the clinician for painful or unpleasant diagnostic or therapeutic procedures
Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam
Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation
Summary
Procedural sedation can provide more comfort for the patient and an easier procedure for the clinician for painful or unpleasant diagnostic or therapeutic procedures It may be preferred over general anesthesia due to physiological, financial and logistical considerations,. Dexmedetomidine (an alpha2-adrenergic agonist) is a relatively new drug, which can be used for procedural sedation. It has sedative and anxiolytic properties and is known for its analgesic potential owing to a reduction of sympathetic tone. The patient can be roused to a lucent state, but when left undisturbed will fall back into a state very similar to natural sleep These are unique properties among the sedative medications in common use. It has been shown to impair the respiratory responses to hypoxia and hypercapnia [2] and can cause hemodynamic effects such as hypertension, hypotension and bradycardia [1]
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