Is dexmedetomidine superior to midazolam as a premedication in children? A meta-analysis of randomized controlled trials
Is dexmedetomidine superior to midazolam as a premedication in children? A meta-analysis of randomized controlled trials
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DOI：
10.1111/pan.12391
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发表时间：
2014-08-01
影响因子：
1.7
通讯作者：
Jiang, Hong
中科院分区：
文献类型：
--
作者：
Sun, Yu;Lu, Yi;Jiang, Hong
背景：在目前发表的文献中，关于右美托咪定与咪达唑仑作为儿童前用药的有效性，存在争议的结果。这项荟萃分析的目的是比较右美托咪胺在儿科患者中的使用情况和咪达唑仑的使用情况。方法：我们检索了PubMed、Cochrane Library、Ovid和Google Scholar数据库中与关键词“dexmedetomidine”、“midazolam”和“Child”匹配的英文文章。从检索到的文章的参考文献列表中确定了其他研究。只有前瞻性随机对照试验(RCT)比较了右美托咪定和咪达唑仑在儿童中的使用情况。从文章中提取数据是由两位作者使用预先设计的Excel电子表格独立完成的。使用METAXL Version 1.3软件的质量效应模型计算二分和连续结果数据的相对危险度(RR)、加权平均差值(WMD)及其相应的95%可信区间(95%CI)。结果：11个预期随机对照试验(829名儿童)符合我们的标准。与咪达唑仑相比，在父母分开时(8个随机对照试验[679名儿童]；相对危险度：1.25；95%可信区间：1.06，1.46)和接受面罩时(7个随机对照试验[559名儿童]；相对危险度：1.17；95%可信区间：1.01，1.36)，右美托咪定预先用药与更令人满意的镇静有关。术后应用右美托咪定可减少急救止痛的次数(6个随机对照试验477名儿童；RR：0.55；95%CI：0.40，0.74)，降低躁动或精神错乱的风险(7个随机对照试验466名儿童；RR：0.59；95%CI：0.40，0.88)和颤抖(3个随机对照试验[192名儿童]；RR：0.33；95%CI：0.18，0.61)。然而，右美托咪定预先用药降低了收缩压(3个RCT[242名儿童]；WMD：-11.47 mm.Hg-1；95%CI：-13.95，-8.98)、平均血压(3个RCT[202名儿童]；WMD：-5.66 mm.Hg-1；95%CI：-8.89，-2.43)，以及心率(6个RCT[444名儿童]；WMD：-12.71次·分(-1)；与咪达唑仑相比，95%CI：-14.80，-10.62)，并延长了镇静起效时间(2个随机对照试验[132名儿童]WMD：13.78分钟；95%CI：11.33，16.23；I-2=0%)。结论：本荟萃分析显示，在父母分离和面罩接受后，右美托咪定预先用药能产生满意的镇静效果，优于咪达唑仑。右美托咪定预先用药可提供临床益处，包括减少对抢救止痛的需求，减少术后期间的躁动或精神错乱和颤抖。然而，心率和血压的风险降低，应考虑与右美托咪定相关的镇静起效时间延长。
Background: In the current published literature, there are controversial results regarding the effectiveness of dexmedetomidine compared with midazolam as premedication in children. The aim of this meta-analysis was to compare the use of dexmedetomidine as a premedication in pediatric patients with that of midazolam.Methods: We searched for articles published in English that matched the key words 'dexmedetomidine', 'midazolam', and 'children' in the PubMed, Cochrane Library, Ovid, and Google Scholar databases. Additional studies were identified from the reference lists of the retrieved articles. Only prospective randomized controlled trials (RCTs) that compared the use of dexmedetomidine and midazolam as premedications in children were included. The extraction of data from the articles was performed independently by two authors using a predesigned Excel spreadsheet. The relative risks (RRs), weighted mean differences (WMDs), and their corresponding 95% confidence intervals (95% CIs) were calculated for dichotomous and continuous outcome data using the quality effects model of the METAXL version 1.3 software.Results: Eleven prospective RCTs (829 children) met our criteria. Compared with midazolam, dexmedetomidine premedication was associated with more satisfactory sedation upon parent separation (eight RCTs [679 children]; RR: 1.25; 95% CI: 1.06, 1.46) and upon mask acceptance (seven RCTs [559 children]; RR: 1.17; 95% CI: 1.01, 1.36). During the postoperative period, premedication with dexmedetomidine lowered the numbers of requests for rescue analgesia (six RCTs [477 children]; RR: 0.55; 95% CI: 0.40, 0.74) and lowered the risks of agitation or delirium (seven RCTs with [466 children]; RR: 0.59; 95% CI: 0.40, 0.88), and shivering (three RCTs [192 children]; RR: 0.33; 95% CI: 0.18, 0.61). However, dexmedetomidine premedication reduced systolic blood pressure (three RCTs [242 children]; WMD: -11.47 mm.Hg-1; 95% CI: -13.95, -8.98), mean blood pressure (three RCTs [202 children]; WMD: -5.66 mm.Hg-1; 95% CI: -8.89, -2.43), and heart rate (six RCTs [444 children]; WMD: -12.71 beat.min(-1); 95% CI: -14.80, -10.62), and prolonged the onset of sedation (two RCTs [132 children] WMD: 13.78 min; 95% CI: 11.33, 16.23; I-2 = 0%) relative to midazolam.Conclusion: This meta-analysis demonstrated that dexmedetomidine premedication is superior to midazolam premedication in terms of producing satisfactory sedation upon parent separation and mask acceptance. Dexmedetomidine premedication provides clinical benefits that included reducing the requirements for rescue analgesia and reducing agitation or delirium and shivering during the postoperative period. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with dexmedetomidine should be considered.