Abstract：
BACKGROUND: Midazolam is routinely used as preanesthetic medication in pediatric patients. Recently, dexmedetomidine has emerged as an alternative as a premedicant. We aimed to add more evidence about the efficacy and safety of two common routes of administration for pediatric premedication: oral midazolam versus intranasal dexmedetomidine.
METHODS: We systematically searched Randomized Controlled Trials (RCTs) involving patients ≤ 18 years old undergoing preanesthetic medication and comparing intranasal dexmedetomidine with oral midazolam. Risk Ratio (RR) and Mean Difference (MD) with 95% Confidence Intervals (95% CI) were computed using a random effects model. Trial-sequential analyses were performed to assess inconsistency.
RESULTS: Sixteen RCTs (1,239 patients) were included. Mean age was 5.5 years old, and most procedures were elective. There was no difference in satisfactory induction or mask acceptance (RR = 1.15, 95% CI 0.97-1.37; p = 0.11). There was a higher incidence of satisfactory separation from parents in the dexmedetomidine group (RR = 1.40; 95% CI 1.13-1.74; p = 0.002). Dexmedetomidine was also associated with a reduction in the incidence of emergence agitation (RR = 0.35; 95% CI 0.14-0.88; p = 0.02). Heart rate and mean arterial pressure were marginally lower in the dexmedetomidine group but without clinical repercussions.
CONCLUSIONS: Compared with oral midazolam, intranasal dexmedetomidine demonstrated better separation from parents and lower incidence of emergence agitation in pediatric premedication, without a difference in satisfactory induction. Intranasal dexmedetomidine may be a safe and effective alternative to oral midazolam for premedication in pediatric patients.
METHODS: We systematically searched Randomized Controlled Trials (RCTs) involving patients ≤ 18 years old undergoing preanesthetic medication and comparing intranasal dexmedetomidine with oral midazolam. Risk Ratio (RR) and Mean Difference (MD) with 95% Confidence Intervals (95% CI) were computed using a random effects model. Trial-sequential analyses were performed to assess inconsistency.
RESULTS: Sixteen RCTs (1,239 patients) were included. Mean age was 5.5 years old, and most procedures were elective. There was no difference in satisfactory induction or mask acceptance (RR = 1.15, 95% CI 0.97-1.37; p = 0.11). There was a higher incidence of satisfactory separation from parents in the dexmedetomidine group (RR = 1.40; 95% CI 1.13-1.74; p = 0.002). Dexmedetomidine was also associated with a reduction in the incidence of emergence agitation (RR = 0.35; 95% CI 0.14-0.88; p = 0.02). Heart rate and mean arterial pressure were marginally lower in the dexmedetomidine group but without clinical repercussions.
CONCLUSIONS: Compared with oral midazolam, intranasal dexmedetomidine demonstrated better separation from parents and lower incidence of emergence agitation in pediatric premedication, without a difference in satisfactory induction. Intranasal dexmedetomidine may be a safe and effective alternative to oral midazolam for premedication in pediatric patients.
摘要：
背景：咪达唑仑通常用作儿科患者的麻醉前药物。最近,右美托咪定已成为一种替代药物.我们的目的是增加更多的证据，证明两种常见的儿科前用药给药途径的有效性和安全性：口服咪达唑仑与鼻内右美托咪定。
方法：我们系统地搜索了随机对照试验（RCT），该试验涉及接受麻醉前药物治疗的年龄≤18岁的患者，并比较了鼻内右美托咪定与口服咪达唑仑。使用随机效应模型计算具有95%置信区间(95%CI)的风险比(RR)和平均差(MD)。进行试验序贯分析以评估不一致性。
结果：纳入16个RCTs（1,239例患者）。平均年龄5.5岁,大多数程序都是选择性的。满意的诱导或面罩接受度没有差异（RR=1.15，95％CI0.97-1.37；p=0.11）。在右美托咪定组中，与父母分离满意的发生率较高(RR=1.40;95%CI1.13-1.74;p=0.002)。右美托咪定还与出现躁动的发生率降低相关(RR=0.35;95%CI0.14-0.88;p=0.02)。右美托咪定组的心率和平均动脉压略低，但无临床影响。
结论：与口服咪达唑仑相比，鼻内右美托咪定在儿科术前用药中表现出与父母更好的分离和更低的苏醒期躁动发生率。没有令人满意的感应差异。鼻内注射右美托咪定可能是口服咪达唑仑的安全有效的替代药物，用于儿科患者的术前用药。
方法：我们系统地搜索了随机对照试验（RCT），该试验涉及接受麻醉前药物治疗的年龄≤18岁的患者，并比较了鼻内右美托咪定与口服咪达唑仑。使用随机效应模型计算具有95%置信区间(95%CI)的风险比(RR)和平均差(MD)。进行试验序贯分析以评估不一致性。
结果：纳入16个RCTs（1,239例患者）。平均年龄5.5岁,大多数程序都是选择性的。满意的诱导或面罩接受度没有差异（RR=1.15，95％CI0.97-1.37；p=0.11）。在右美托咪定组中，与父母分离满意的发生率较高(RR=1.40;95%CI1.13-1.74;p=0.002)。右美托咪定还与出现躁动的发生率降低相关(RR=0.35;95%CI0.14-0.88;p=0.02)。右美托咪定组的心率和平均动脉压略低，但无临床影响。
结论：与口服咪达唑仑相比，鼻内右美托咪定在儿科术前用药中表现出与父母更好的分离和更低的苏醒期躁动发生率。没有令人满意的感应差异。鼻内注射右美托咪定可能是口服咪达唑仑的安全有效的替代药物，用于儿科患者的术前用药。
