Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

Abstract

Background Dexmedetomidine (DEX), an α₂-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane. Methods PubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables. Results Twelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57-0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35-0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35-0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting. Conclusion Compared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.

Keywords: Dexmedetomidine; meta-analysis; midazolam; paediatric anaesthesia; sevoflurane.

Figure 1.

Flow chart of study selection.

Figure 2.

Quality assessment of included randomized controlled trials. (a) Risk-of-bias summary: review authors’ judgments regarding each risk-of-bias item for each included study. (b) Risk-of-bias graph: review authors’ judgments regarding each risk-of-bias item presented as percentages across all included studies.

Figure 3.

Funnel plot for incidence of unsatisfactory sedation to assess publication bias. RR: risk ratio.

Figure 4.

Forest plot for primary outcomes: incidence of unsatisfactory (a) sedation, (b) parental separation, and (c) mask acceptance during induction between the dexmedetomidine and midazolam groups. M-H: Mantel–Haenszel method; 95%CI: 95% confidence interval.

Figure 5.

Forest plot for secondary outcomes: comparison of postoperative complications including (a) emergence agitation, (b) rescue analgesia, and (c) postoperative nausea and vomiting between the dexmedetomidine and midazolam groups. M-H: Mantel–Haenszel method; 95%CI: 95% confidence interval; IV: inverse variance.