Midazolam Group Research Articles

Effects of Ketamine vs. Midazolam in Adolescent Treatment Resistant Depression

Background: Adolescent treatment resistant depression (TRD) is increasing in recent years. While ketamine showed rapid antidepressant effects in adult TRD studies, research on its effectiveness in adolescents is limited. Methods: This study examines the effects of intravenous ketamine vs. midazolam on depressive and anxiety symptomatology assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Children’s Depression Inventory (CDI) at two time points—2 h after initial infusion (T0+2h) and 24 h after the end of the treatment (Te+24h) in a sample of 55 adolescent TRD females (27 receiving ketamine, 28 midazolam). Results: At T0+2h, within-group comparisons revealed a significant reduction in MADRS and HAM-A scores compared to baseline in the ketamine and midazolam groups. At Te+24h, both groups demonstrated similar significant reductions in MADRS, HAM-A, and CDI scores compared to baseline. The MADRS assessment in the ketamine group showed 33% and 59% responders, and in the midazolam group, 14% and 46% responders at T0+2h and Te+24h, respectively. HAM-A evaluation in the ketamine group revealed 33% and 56% responders, and in the midazolam group, 11% and 39% responders at T0+2h and at Te+24h, respectively. CDI rating discovered 11% and 44% responders in the ketamine group and 4% and 21% responders in the midazolam group at T0+2h and Te+24h, respectively. Moreover, inner tension significantly decreased in ketamine compared to the midazolam group at Te+24h. Conclusions: Ketamine showed a reduction in depressive and anxiety symptoms during a short-term period with particular efficacy in alleviating inner tension over midazolam, suggesting its potential advantages in specific symptom relief in rarely studied adolescent TRD.

The Effect of Dexmedetomidine on Inflammatory Factors and Clinical Outcomes in Patients With Septic Shock: A Randomized Clinical Trial

PurposeDexmedetomidine is a sedative-analgesic that is widely used in sepsis. However, its effect on septic shock remains unclear. This study aimed to investigate dexmedetomidine's effect on inflammatory biomarkers in septic shock. MethodsThe present study was a randomized controlled clinical trial. Patients with inclusion criteria were randomly allocated into either the dexmedetomidine (n = 24) or morphine + midazolam group (n = 24). The primary outcome was changes in inflammatory factors, including IL-1, IL-6, TNF-α, ESR, and CRP. The serum levels of inflammatory factors were measured at baseline and the end of the intervention. Secondary outcomes included the change in norepinephrine dose, vital signs, and SOFA scores. FindingsOf the 48 subjects, 52.08% were male. After intervention, IL-1, IL-6, and TNF-α levels significantly differed between the 2 groups (p = 0.011 and p < 0.001 and p < 0.001, respectively). Heart rate and systolic blood pressure decreased over time, but the two groups had no significant difference (p-value > 0.05). In addition, there was no significant difference in norepinephrine dose and SOFA score between the 2 groups (p-value > 0.05). ImplicationsSedation with dexmedetomidine can attenuate the inflammatory factors in septic shock. Also, dexmedetomidine did not worsen the hemodynamic parameters in septic shock patients.

Efficacy and safety of remimazolam tosilate in anesthesia for short otolaryngology surgery

BackgroundRemimazolam tosilate represents the novel ultrashort-acting benzodiazepine drug. This work focused on exploring whether remimazolam tosilate was effective and safe in anesthesia for short otolaryngology surgery in adults, and optimize its medication regimen, thus providing a theoretical basis for its widespread clinical application.MethodsThe present unicentric, double-blind, randomized controlled study enrolled altogether 85 otolaryngology surgery patients aged 18–60 years, and they were divided as remimazolam (RM, 42 cases) or midazolam (MD, 43 cases) group. Efficacy outcomes included successful sedation time, sedation effect (Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score), bispectral index values (BIS), and postoperative recovery. The safety outcomes were patient vital signs at each time point (before induction (T0), 2 min and 5 min after trial drug treatment (T1 and T2 separately), during successful intubation (T3), at the end of surgery (T4), during extubation (T5), and at the time of exiting the room (T6)), any adverse reactions (AEs) during perioperative period, and patient satisfaction with anesthesia experience.ResultsDemographics were not significantly different in both groups (P > 0.05). RM group had significantly decreased successful sedation time relative to MD group (P < 0.05), while increased successful sedation rate (100%) relative to MD group (90.70%, P = 0.116). RM group showed decreased MOAA/S score and BIS value compared with MD group at T1 and T2 (P < 0.05). The spontaneous respiration recovery time and extubation time were not significantly different in both groups (P > 0.05), but RM group exhibited decreased discharge time compared with MD group (P < 0.05). Compared with MD group, the RM group had lower blood pressure (BP) at T3 (P < 0.05); whereas higher heart rate (HR) and respiration rate (RR) at T1 and T2 (P < 0.05). Difference in AEs was not of statistical significance. Finally, RM group exhibited the increased satisfaction of anesthesia experience compared with MD group (P < 0.05).ConclusionRemimazolam tosilate is effective on anesthesia for short otolaryngology surgery. Remimazolam shows the rapid onset, stable circulation, fast postoperative recovery, no increase in perioperative AEs, and high satisfaction with anesthesia experience compared with midazolam.Trial Registrationhttps://www.chictr.org.cn/ (ChiCTR2200067123) on 27/12/2022. This study was consistent with CONSORT guidelines.

Comparison of Hemodynamic Effects of Remimazolam and Midazolam During Anesthesia Induction in Patients Undergoing Cardiovascular Surgery: A Single-Center Retrospective and Exploratory Study.

Patients undergoing cardiovascular surgery may experience hemodynamic instability during the induction of general anesthesia, and anesthetic agents with minimal hemodynamic effects should be administered. Midazolam, a classic benzodiazepine anesthetic, is known to have relatively weak circulatory depression during anesthesia induction compared to other sedatives. On the other hand, remimazolam, a newly approved short-acting benzodiazepine anesthetic, is expected to have fewer circulatory depressant effects. However, comparisons between remimazolam and midazolam regarding circulatory depression during anesthesia induction have not been adequately studied. This study aims to compare the hemodynamic effects of remimazolam and midazolam during anesthesia induction in patients undergoing cardiovascular surgery. In this single-center retrospective and exploratory study, adults undergoing cardiovascular surgery under general anesthesia were divided into the remimazolam group (R group) and midazolam group (M group). Remimazolam 0.06 mg/kg (R group) or midazolam 0.03 mg/kg (M group) was administered during induction of general anesthesia. Both groups received remifentanil 1 μg/kg/min as analgesia. During anesthesia induction, additional sedatives (remimazolam or midazolam, respectively) were administered as needed to maintain the bispectral index (BIS) below 60. The primary endpoints were the following hemodynamic parameters: mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), and stroke volume variation (SVV). Measurements were taken before the induction of anesthesia, one and three minutes after rocuronium administration, and one, three, five, and 10 minutes after tracheal intubation. Secondary endpoints included the number of patients requiring vasopressors and vasopressor dosage, time to fall asleep, and BIS values. All values are expressed as the median (interquartile range). Continuous variables were compared using the Mann-Whitney U test. Statistically significant differences were set at p-values <0.05. Forty patients (20 in each group) were included in the final analysis. The doses of remimazolam and midazolam until sleep onset were 0.058 (0.053, 0.066) mg/kg in the R group and 0.035 (0.03, 0.045) mg/kg in the M group. The MAP at five minutes and 10 minutes after tracheal intubation was significantly higher in the R group than in the M group (p=0.031 and p=0.004, respectively). The HR, CI, SVI, SVRI, and SVV were not significantly different between the two groups at any of the measurement points. The number of patients requiring vasopressors and vasopressor dosage were not statistically significant between the two groups. The time to fall asleep was 124 seconds (90, 142) in the R group and 146 seconds (130, 167) in the M group, with a significant difference (p=0.01). The BIS values during anesthesia induction were not significantly different between the two groups. Remimazolam had fewer hemodynamic effects than midazolam, even with relatively high doses and an earlier sleep onset. In terms of hemodynamic stability, remimazolam may be beneficial during anesthetic induction; however, further research is needed to confirm its efficacy.

Vasopressor utilization in septic shock patients receiving propofol versus midazolam

PurposeThe purpose of this study was to evaluate the effect of propofol versus midazolam on vasopressor requirements in patients with septic shock to better guide sedative selection. MethodsThis was a multicenter, retrospective, observational, IRB-approved, non-inferiority cohort study. Included individuals were ≥ 18 years of age, had a diagnosis of septic shock, and exclusive administration of propofol or midazolam for at least 12 h. The primary outcome was maximum increase in vasopressor requirements within the first 12 h following sedative initiation. ResultsFor the primary outcome of maximum increase in norepinephrine equivalents (NEE) within 12 h, propofol was non-inferior to midazolam (0.09 vs. 0.129 μg/kg/min, p = 0.002). No difference was seen between the propofol and midazolam groups for the secondary outcome of maximum increase in NEE within 3 h (0.02 vs 0.04 μg/kg/min, p = 0.208), however, the propofol group had a significantly lower increase within 6 h (0.06 vs 0.086 μg/kg/min, p = 0.043) and 24 h (0.11 vs 0.25 μg/kg/min, p = 0.013). ConclusionIn patients with septic shock, vasopressor requirement increases with propofol were non-inferior to midazolam within the first 12 h.

Ketamine plus midazolam compared to midazolam infusion for the management of refractory status epilepticus

BackgroundData for the use of ketamine (Ket) in treatment of refractory and super-refractory status epilepticus (RSE, SRSE) is lacking despite its widespread growing use. We examined the efficacy of ketamine plus midazolam (MDZ) infusions for treating RSE versus midazolam alone. We hypothesized that ketamine initiation would result in earlier seizure termination. MethodsData was obtained from electronic health records (EHR) of adult patients who received intravenous anesthetic agents for RSE in our neurointensive care unit. Two cohorts were identified. The MDZ cohort received midazolam as the only intravenous anesthetic agent for RSE. The Ket+MDZ cohort received midazolam infusion followed by ketamine infusion. The primary outcomes were time from midazolam infusion start to SE end in both cohorts, and time from ketamine infusion start (Ket Start) to SE end in the Ket+MDZ cohort versus midazolam infusion start (MDZ start) to SE end in the MDZ cohort. Results73 patients were included (MDZ cohort n=17, Ket + MDZ cohort n=56). Cohorts did not differ significantly in age, sex, race, RSE etiology, or GCS on admission. Mean APACHE II score was higher in the Ket +MDZ cohort (26 ± 7.32 SD) versus the MDZ cohort (22 ± 5.89 SD)(P=.015). In survival analyses, cohorts did not differ significantly in time from midazolam start to SE end (HR=0.965, 95 % CI=0.556–1.673, P=.899; median [IQR]: MDZ: 25 h [4.5–58]; Ket+MDZ: 21.5 h [IQR 13.5–49]). Time from Ket start (Ket+MDZ group) versus time from MDZ start (MDZ group) to SE end was significantly shorter in the Ket+MDZ cohort (HR=1.895, 95 % CI=1.083–3.314, P=.025). The pattern of results was similar when including APACHE II and MDZ maximum dosage as covariates. ConclusionTime to SE end was significantly shorter after addition of ketamine infusion to midazolam infusion, versus after initiation of midazolam infusion monotherapy. Patients with higher disease severity favored Ket+MDZ. Randomized controlled trials are warranted in determining optimal anesthetics in RSE and SRSE.

Comparison of remimazolam and midazolam for preventing intraoperative nausea and vomiting during cesarean section under spinal anesthesia: a randomized controlled trial.

Preventing intraoperative nausea and vomiting (IONV) is crucial for maternal safety during cesarean section under spinal anesthesia. While midazolam is known to prevent IONV, we hypothesized that remimazolam would be superior due to its minimal hemodynamic effects. We compared the effects of the two drugs on IONV. Parturients scheduled for cesarean section were randomly assigned to receive either midazolam or remimazolam. They received midazolam 2 mg or remimazolam 5 mg, with additional doses administered upon request. The primary outcome measure was the incidence of newly developed IONV during sedation. Other outcomes included overall IONV, rescue antiemetic use, shivering, hemodynamic variables, sedation scale scores, and satisfaction scores. Data from 80 participants were analyzed. Deeper sedation was induced in the remimazolam group (PGroup × Time < 0.001) despite comparable hemodynamic trends between the groups. The incidence of overall IONV was comparable between the two groups (27.5% in the midazolam group vs. 17.5% in the remimazolam group, absolute risk reduction [ARR]: 0.100, 95% confidence interval [CI] [-0.082, 0.282], P = 0.284); however, newly developed IONV during sedation was significantly reduced in the remimazolam group (20.0% vs. 5.0%, ARR: 0.150, 95% CI [0.009, 0.291], P = 0.043). The need for rescue antiemetics was also lower in the remimazolam group (15.0% vs. 2.5%, ARR: 0.125, 95% CI [0.004, 0.246], P = 0.048). Remimazolam significantly reduced the incidence and severity of newly developed IONV compared with midazolam, with minimal impact on hemodynamics, making it a useful sedative option for cesarean section.

Intranasal Dexmedetomidine (Precedex) versus Intranasal Midazolam (Dormicum) as a Premedication in Pediatrics Undergoing Upper GI Endoscopy

Abstract Background Upper GI endoscopy is one of the most common surgical procedures performed in pediatric patients. Relieving pre- and post- operative anxiety is an important concern for the pediatric anesthesiologist. Anxiety can produce aggressive reactions, increase distress, and may make the control of postoperative pain difficult. Pre-anesthetic medication in children should aim at relieving this anxiety and psychological trauma and also to facilitate the induction of anesthesia without prolonging the recovery. Aim of the Work The aim of this work is to compare the effectiveness of intranasal dexmedetomidine and midazolam as a premedication in sedation of preschool children in GI endoscopy. Patients and Methods A prospective, randomized and double blind clinical trial was done after approval of institutional ethics committee in Ain Shams University Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include 70 pediatric patients, aged 2 to 6 years old of both genders, with physical status ASA I – II. Results In the present study, the children were satisfactorily separated from parents in dexmedetomidine group when compared to the midazolam group; p value &amp;lt;0.001 as also documented by Ayushi that Parental separation was successful in 73.3% of patients in Group SD compared with 46.7% of patients in Group SM (P = 0.035). Furthermore, children in dexmedetomidine group achieved significant lower agitation and delirium postoperative after drug in comparison to midazolam group; regarding delirium: p value &amp;lt;0.001, and regarding agitation: p value &amp;lt;0.001. Conclusion Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower agitation and delirium in the postoperative period as compared to intranasal midazolam 0.2 mg/kg in children undergoing upper GI endoscopy although dexmedetomidine had a delayed onset of action when compared to that of midazolam.

Efficacy and safety of intravenous thiamylal in sedation for colonoscopy in children.

Since a standard sedation protocol for pediatric colonoscopy (CS) has not been established, evidence on optimal sedative agents is needed. This study aimed to evaluate the efficacy and safety of thiamylal in sedation for pediatric CS compared to midazolam. Children from 7 to 16 years of age who underwent CS under sedation with intravenous thiamylal or midazolam at our hospital between June 2010 and March 2024 were included in this retrospective observational study. The primary outcome was the efficacy (success rate of CS without mid-awakening) of the drugs. Meanwhile, the secondary outcomes were the sedation level during CS, procedure time, recovery time, and adverse events related to sedation. Sixty children were included in the study. The success rate of CS without mid-awakening was significantly higher in the thiamylal group (90.6%) than in the midazolam group (64.3%; p = 0.03). The two groups had no significant differences in median sedation depth, procedure time, or recovery time. Adverse events related to sedation in thiamylal group (22%) and midazolam group (25%) were similar. No severe adverse events were reported. Intravenous thiamylal provides effective and safe sedation in children requiring CS, with little or no mid-awakening during the procedure.

Comparison of Dexmedetomidine and Midazolam for Preoperative Sedation in Patient Under Going Surgeries Under Spinal Anaesthesia

Preoperative anxiety is a frequent condition. Generally, it starts two days before the operation and reaches its peak just prior to induction of anesthesia. Anxiety, stress, and fear that arise just before the operation and anesthesia may lead to psychological trauma and increase the levels of stress hormones, resulting in undesirable metabolic responses before anesthesia. In our study primary objective was to compare the effectiveness of dexmedetomidine and midazolam with control group in preoperative sedation prior to surgical procedures. Considering the sample size and methodology of the seed article a sample size of 207 was obtained This prospective, hospital based, comparative study was conducted in Department of Anesthesia, Mahatma Gandhi Medical College &amp; Hospital, Jaipur over a period from March 2023 to august 2024. Group C was control, Group D was dexmedetomidine, and Group M was the midazolam group. Patients of Group C were given 100 ml of physiological saline over 10 min. patients of Group D were given 0.25 µg/kg dexmedetomidine in 100 ml physiological saline over 10 min. Group M were given 0.03 mg/kg midazolam in 100 ml physiological saline over 10 min. Group D (dexmedetomidine group) has significantly lower bromage score, Anxiety, and VAS scores, demonstrating better overall recovery, reduced anxiety, and less pain as compare to other two group. Also group D patient show better stabilization of vital parameter.

A Comparison of the Use of Propofol versus Midazolam for Pediatric Magnetic Resonance Imaging Sedation: Retrospective Cohort Study.

The aim of the present study was to do a comparison of the recovery profiles and airway-related adverse events of pediatric magnetic resonance imaging (MRI) sedation patients who received propofol alone to those who received midazolam alone. This retrospective cohort study was approved by the Mutah University Ethical Approval Committee (No. 2378). A search of the patients' medical records was performed between September 2021 and April 2022 to identify children aged 4 months-11 years who received propofol or midazolam for MRI sedation. The patients were subdivided into two groups: Those who had propofol alone (propofol group) and those who received midazolam (midazolam group) for pediatric MRI sedation. In propofol group, a 1-2 mg/kg of propofol bolus was given to have a deep sedation (Ramsay Sedation Scale score of 5). Patients in midazolam group received 0.05 mg/kg of midazolam. During the maintenance state of sedation, the patient received 150 µg/kg/min of propofol, and the infusion rate was adjusted in 25 μg/kg/min increments up or down at the discretion of the anesthesiologists to maintain a state of deep sedation. The major targets of this study were recovery profiles (time to awake and time to discharge) and airway-related intervention ratios in pediatric MRI sedation patients. Patient demographics, MRI sedation, and recovery data, including propofol induction dose, airway intervention, and sedation-related adverse events from the pediatric sedation recovery unit were also collected. The mean (standard deviation [SD]) propofol induction dose was higher compared to midazolam group (2.4 [0.7] mg vs. 1.3 [0.5] mg; mean difference, 1.1 mg; P < 0.001). The mean (SD) infusion rate was higher in propofol group compared to midazolam group (161.3 [37.6] μg/min/kg vs. 116.2 [25.6] μg/min/kg; mean difference 45.1 μg/min/kg; P < 0.001). The mean (SD) propofol total dose was higher in propofol group compared to midazolam group (236.3 [102.4] mg vs. 180.7 [80.9] mg; mean difference, 155.4 mg; P < 0.001). The mean (SD) time to awake was longer in midazolam group compared to propofol group (21.2 [5.6] min vs. 23.0 [7.1] min; mean difference, 1.8 min; P < 0.001). The mean (SD) time to discharge was longer in midazolam group compared to propofol group (34.5 [6.9] min vs. 38.6 [9.4] min; mean difference, 4.1 min; 95% confidence interval, 3.0-5.1; P < 0.001). The administration of midazolam during pediatric MRI sedation can decrease the frequency of airway complications without prolonging the clinically significant recovery profile.

Comparison of the Cardiovascular Response to Sedation with Dexmedetomidine, Midazolam, and Etomidate in Phacoemulsification under Local Topical Anesthesia; A Double-Blind Randomized Controlled Clinical Trial.

The present study aimed to compare the cardiovascular response to sedation with dexmedetomidine, midazolam, and etomidate during phacoemulsification under local Topical anesthesia. In this double-blind randomized clinical trial, a total of 90 cataract surgery candidates undergoing phacoemulsification were selected and divided into three groups. The first group received 1 µg/kg dexmedetomidine over 10 minutes, followed by an infusion of dexmedetomidine at a rate of 0.5 µg/kg/h. The second group received 0.05 mg/kg midazolam, and the third group received 0.2 mg/kg slow IV etomidate. Hemodynamic parameters, sedation level, and adverse effects were recorded before anesthesia, during surgery, and during recovery. The results of this study showed that in the 10th minute of surgery, the systolic blood pressure (SBP) in the etomidate group was significantly higher than the other groups P value = 0.029). The pulse rate (PR) in the etomidate group at the 15th minute during surgery, 10th, 20th, and 30th minute in the recovery period (mean 70.33 ± 10.34 bpm, 72.10 ± 10.18 bpm, 73.70 ± 10.18 bpm, and 75.03 ± 6.73 bpm, respectively) was significantly higher than the other two groups (P value < 0.05). No adverse effects such as dizziness, restlessness, vomiting, or nausea were observed in the midazolam group. However, decreased heart rate was significantly higher in the dexmedetomidine group (26.7%) compared to the etomidate (3.3%) and midazolam (6.7%) groups (P value = 0.021). According to the results of this study, the sedation level achieved by dexmedetomidine, midazolam, and etomidate was similar. However, etomidate seemed to have a better effect on maintaining blood pressure and pulse rate compared to the other two drugs.

Efficacy and safety of rectal chloral hydrate for pediatric procedural sedation: A systematic review and meta-analysis.

To evaluate the efficacy and safety of rectal chloral hydrate (CH) in pediatric procedural sedation. Seven electronic databases and 3 clinical trials registry platforms were searched, and the deadline was August 2022. Randomized controlled trials evaluating the efficacy and safety of rectal CH in pediatric procedural sedation were included by 2 reviewers. The extracted outcomes included the success rate of sedation, sedation latency, sedation duration, and adverse events. The Cochrane risk of bias tool was used to assess the risk of bias. The outcomes were analyzed using Review Manager 5.3 software. Forty-four randomized controlled trials with 8007 children were included in the meta-analysis. The success rate of sedation in the rectal CH group was significantly higher than that in the placebo group (risk ratio [RR], 2.60 [95% confidence interval [CI], 1.74-3.89]; P < .01; RR, 1.24 [95% CI, 1.01-1.54]; P = .04), oral CH group (RR, 1.12 [95% CI, 1.09-1.14]; I2 = 36%; P < .001; number needed to treat [NNT] = 10), diazepam group (RR, 1.21 [95% CI, 1.10-1.33]; I2 = 0%; P < .001; NNT = 6), phenobarbital group (RR, 1.24 [95% CI, 1.13-1.35]; I2 = 12%; P < .001; NNT = 6), and ketamine group (RR, 1.39 [95% CI, 1.20-1.60]; I2 = 20%; P < .001; NNT = 5). There was no significant difference in the success rate of sedation between the rectal CH group and the midazolam group (RR, 0.98 [95% CI, 0.86-1.11]; I2 = 51%; P > .05). The sedation latency was significantly shorter in rectal CH group than that in the oral CH group (mean difference [MD], -6.36 [95% CI, -7.04 to -5.68]; I2 = 49%; P < .001) and the phenobarbital group (MD, -7.64 [95% CI, -9.12 to -6.16]; P < .00001). The sedation duration in the rectal CH group was significantly longer than in the oral CH group (MD, 6.43 [95% CI, 4.39-8.47]; I2 = 0%; P < .001). The overall incidence of adverse events was significantly lower with rectal CH than with oral CH (RR, 0.21 [95% CI, 0.16-0.29]; I2 = 45%; P < .001) and ketamine (RR, 0.26 [95% CI, 0.12-0.60]; I2 = 0%; P = .001). There was no significant difference in the overall incidence of adverse events with rectal CH compared with intramuscular midazolam (RR, 0.55 [95% CI, 0.23-1.28]; P = .17) and intranasal midazolam (RR, 3.00 [95% CI, 0.66-13.69]; P = .16). The available evidence suggests that rectal CH cloud be an effective and safe sedative agent for pediatric procedural sedation.

Intranasal midazolam for procedural distress in children in the emergency department: a systematic review and meta-analysis.

Intranasal (IN) midazolam is the most common anxiolytic for children in the emergency department (ED), but evidence of benefit is conflicting. We synthesized the evidence on IN midazolam for procedural distress in children undergoing ED painful procedures. We included trials involving painful ED procedures in children 0-18years involving IN midazolam. Primary outcome was procedural distress. We summarized results using Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," and "unfavorable" (p < 0.05), supporting IN midazolam or comparator, respectively, or "indeterminate" (unable to judge). Where possible, we pooled results using meta-analysis.Methodologic quality of evidence was evaluated using Cochrane Collaboration's risk of bias tool and GRADE system. We included 41 trials (n = 2973 participants). Thirty trials involved intravenous insertion. IN midazolam was superior to placebo (RR = 7.2; 95% CI: 3.43, 15.25; 3 trials; I2 = 0%). However, 56-90% of the IN midazolam group resisted the procedure. Focusing on the three trials that used validated measures, IN midazolam was "neutral" versus IN ketamine and either "neutral" or "unfavorable" versus IN dexmedetomidine. There was no difference in the proportion of children with a satisfactory distress score between IN midazolam and oral midazolam (RR = 1.1; 95% CI: 0.74, 1.73; 2 trials; I2 = 53%), IN ketamine (RR = 1.1; 95% CI: 0.91, 1.25; 6 trials; I2 = 0%), or IN dexmedetomidine (RR = 0.4; 95% CI: 0.17, 1.05; 3 trials; I2 = 84%). Ten trials involved laceration repair. IN midazolam was "favorable" versus placebo; however, both groups scored in the anxious range. There was no difference in distress between IN midazolam and oral midazolam (SMD = 0.01; 95% CI:-0.32, 0.34; 2 trials; I2 = 0%) (Fig.3E) [64,65]. Using validated instruments, IN midazolam was "unfavorable" versus IN dexmedetomidine but "favorable" versus oral diazepam and placebo. There is limited methodologically rigorous evidence that IN midazolam is better than placebo for IV insertion and laceration repair. At the doses studied, preliminary evidence suggests that IN dexmedetomidine may be superior to IN midazolam for both IV insertion and laceration repair.

Comparing the Effect of Acupressure and Oral Midazolam on Controlling Preoperative Anxiety in Children: A Randomized Trial

Background: Preoperative anxiety in children is a common problem that can affect the anesthesia and postoperative period. Numerous methods, mainly pharmacological ones, have been used for controlling preoperative stress. Acupressure is a simple, noninvasive, and cost-effective method that has been used as a perioperative medicine for controlling pain or preventing postoperative nausea and vomiting. The present study aimed to comparatively investigate the effect of acupressure and oral midazolam on preoperative anxiety control. Methods: 76 patients were randomly included in the study before surgery. Whereas in one group, 0.5 mg/kg oral midazolam was prescribed 15 minutes before the induction, in another group, acupressure of EXHN-3 point was applied for 15 minutes. In both groups, the patients’ separation anxiety level, Ramsay score, recovery length, and RN satisfaction factor were recorded and compared. Results: Children aged 1–7 years received either oral midazolam or acupressure. Although the children in the midazolam group had lower rates of preoperative anxiety and showed easier separation from their parents, the difference was not statistically significant P= (0.076). Ramsay sedation scale, was compared in the two groups. The overall difference was not statistically significant. The satisfaction of the PACU nurse was recorded using a 4-point scale. The two groups were statistically comparable in this regard (P=0.155). The only variable with a significant difference between the two groups was the mean recovery time, which was significantly shorter in acupressure group (P&lt;0.001). Conclusion: Acupressure can reduce preoperative anxiety in children; however, this effect is less than the effect of oral midazolam.

Comparing the Hemodynamic Effects of Midazolam, Etomidate, and Propofol following Anesthesia Induction in Coronary Artery Bypass Graft Surgery: A Double-Blind Randomized Clinical Trial

Background: Hemodynamic disorders during anesthesia lead to complications. To reduce hemodynamic complications, this study was conducted to compare midazolam, etomidate, and propofol following anesthesia induction in patients undergoing coronary artery bypass grafting surgery (CABG). Methods: A double-blind, randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to 1 of 3 groups receiving propofol, etomidate, or midazolam. Hemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and 1 and 5 minutes after intubation. Results: Ninety patients with coronary artery disease (mean age: 60.83 y) were included in the study. Women and men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and MABP exhibited significant decreases in all 3 groups after intubation. The etomidate group demonstrated the least change in SBP (P&lt;0.001) and MABP (P&lt;0.001), followed by the midazolam group. Concerning HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). After intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared with the levels during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure during intubation, a significant difference across all 3 groups (P&lt;0.001). Conclusion: This study, conducted on candidates for CABG, demonstrated that anesthesia induction with etomidate and midazolam resulted in less variation in hemodynamic variables compared with propofol.

Advantages of remimazolam for sedation in impacted tooth extraction.

This study aims to compare the sedative effects of remimazolam and midazolam during impacted tooth extraction to provide a comfortable sedation treatment for patients with dental anxiety. A prospective randomized controlled trial was conducted, in which 60 patients undergoing intravenous sedation for mandibular impacted third molar extraction were evenly divided into either the remimazolam or midazolam group. Prior to receiving a nerve blocker, the patients were sedated with remimazolam or midazolam. Various parameters were recorded and analyzed, including onset time, awakening time, recovery time, modified dental anxiety scale (MDAS) scores before and after surgery, patient-doctor satisfaction levels, postoperative side effects within 24 hours, heart rate (HR), and mean arterial pressure (MAP) at different time points. Compared with the midazolam group, patients in the remimazolam group demonstrated significantly shorter onset, awakening, and recovery times as well as lower postoperative MDAS scores and higher levels of patient-doctor satisfaction. Fewer postoperative side effects were reported in the remimazolam group, although the differences were not statistically significant. The use of remimazolam demonstrates faster onset and recovery, superior efficacy in reducing dental anxiety, and enhanced satisfaction among patients and doctors, thereby presenting distinct advantages for sedation treatment for patients with dental anxiety.

Effects of moderate sedation induced by propofol or midazolam on intracranial pressure

Introduction: Propofol and midazolam are the main options for moderate sedation in clinical practice. In addition, these drugs are used to reduce intracranial pressure in cases of intracranial hypertension, and their use in these situations is guided by limited evidence. Objective: To compare the effects of propofol and midazolam on intracranial pressure wave morphology in moderate sedation in patients undergoing upper digestive endoscopy. Methods: Sixty patients were included in this study, being divided into two groups, propofol and midazolam group. Intracranial pressure was monitored during and after upper digestive endoscopy, using non-invasive monitoring equipment developed by the company Brain4care. Arterial pressure was measured before and after the exam. Results: The propofol group had lower intracranial pressure (p=0.037) during moderate sedation compared to intracranial pressure after endoscopy and a significant decrease in systolic (p=0.0001) and diastolic pressure (p=0.001) after sedation. Midazolam, on the other hand, reduced systolic pressure (p=0.001), but didn’t change the other parameters after the procedure. There wasn’t a significant difference between the propofol and midazolam groups. Conclusion: There was no significant difference between the groups studied, however, analyses within the propofol and midazolam groups indicate that propofol, but not midazolam, causes changes in intracranial pressure in moderate sedation.

Comparing the Effects of Midazolam and Ondansetron in Postoperative Nausea and Vomiting

Background: Nausea and vomiting after a cesarean section (CS) are among the common side effects that cause dissatisfaction among doctors. The aim of this study was to compare the effects of intravenous midazolam and ondansetron on the reduction of nausea and vomiting after spinal anesthesia in CS. Methods: This double-blind clinical trial study was conducted on CS candidates who underwent spinal anesthesia (N=80). After spinal anesthesia, the patients were randomly divided into two groups. Midazolam was administered to one group and ondansetron to the other group. The severity of nausea, the severity of vomiting, and the degree of satisfaction were recorded during surgery and recovery. Results: No significant difference was observed between the two groups in terms of the severity of nausea and vomiting. In addition, the results demonstrated that the level of satisfaction in the midazolam group was higher than that in the ondansetron group, but this difference was not statistically significant (P&lt;0.05). Conclusion: The results of this study showed that midazolam can reduce nausea and vomiting. On the other hand, the results confirmed that both ondansetron and midazolam can have the same effects on reducing nausea and vomiting.

Comparison of the effects of child-centered playful companionship and pharmacological sedation in alleviating preoperative anxiety in preschool children

Objective: To investigate the effectiveness of child-centered playful companionship and sedative medication in alleviating preoperative anxiety in preschool children. Methods: A retrospective analysis was conducted on 3 825 preschool children (3-6 years) who underwent elective surgery at Shanghai Children's Medical Center from April 2021 to March 2022. The children were divided into three groups based on the preoperative anxiolytic intervention: child-centered playful companionship group (n=2 198), pharmacological sedation group (n=1 281), and no intervention group (n=346). The pharmacological sedation group received intranasal dexmedetomidine at 2 μg/kg or oral midazolam syrup at 0.5 mg/kg. The child-centered playful companionship group received care from certified preoperative sedation nurses using a child-centered playful nursing model. The no intervention group did not receive any anti-anxiety measures due to various subjective and objective reasons. Preoperative separation anxiety scores (PSAS), sedation medication usage, and Ramsay sedation scores were recorded for all children. The primary outcome was the success rate of separation based on PSAS scores across different anxiolytic intervention groups, while the secondary outcome was the Ramsay sedation score. Results: The child-centered playful companionship group included 1 462 boys and 736 girls, with a median age [M (Q1, Q3)]of 59 (49, 69) months. The pharmacological sedation group included 824 boys and 457 girls, with a median age of 52 (42, 61) months; and the no intervention group included 212 boys and 134 girls, with a median age of 57 (48, 69) months. The success rate of separation in the child-centered playful companionship group was 95.6% (2 102/2 198), and in the pharmacological sedation group was 93.8% (1 202/1 281), both significantly higher than the 43.6% (151/346) of the no intervention group (all P<0.05). Among the 1 281 children in the pharmacological sedation group, 785 received oral midazolam and 496 received intranasal dexmedetomidine. Compared to the intranasal dexmedetomidine group, the oral midazolam group was younger, had a lower body weight and a higher proportion of American Society of Anesthesiologists (ASA) class Ⅲ (all P<0.05). The success rate of separation was 93.4% (733/785) in the oral midazolam group and 94.6% (469/496) in the intranasal dexmedetomidine group, with no statistically significant difference (P=0.392). The Ramsay sedation score was 2 (2, 2) in the intranasal dexmedetomidine group, better than the 2 (2, 2) of the oral midazolam group (P=0.024). Conclusion: Both child-centered playful companionship and pharmacological sedation effectively alleviate preoperative anxiety in preschool children.