Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials

BMC Anesthesiology

Research

Qianqian Zhang¹  Shouming Chen²  Liang Huang³  Lingli Zhang³  Bingchen Lang³  Yuzhi Fu³  Linan Zeng³  Zhi-jun Jia⁴  Huiqing Wang⁵ 

[1] Department of Anesthesiology, Chengdu Women’s and Children’s Central Hospital, Chengdu, China;Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China;Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China;Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, 610041, Chengdu, China;Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China;National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China;Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China;Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, 610041, Chengdu, China;Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China;National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China;Department of Biopharmaceutics, West China School of Pharmacy, Sichuan University, Chengdu, China;Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, China;

关键词: Midazolam;    Ketamine;    Intranasal;    Sedation;    Pediatrics;   

DOI  :  10.1186/s12871-022-01892-2

 received in 2022-07-20, accepted in 2022-10-31,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundIntranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. We conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients.MethodsWe searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study.ResultsA total of 16 studies with 1066 patients were enrolled. Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure (SMD = -0.53, with 95% CI [-0.93, -0.13]) and heart rate (HR) (SMD = -1.39, with 95% CI [-2.84, 0.06]). Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level (61.76% vs 40.74%, RR = 1.53, with 95%CI [1.28, 1.83]), more rapid onset of sedation (SMD = -0.59, with 95%CI [-0.90, -0.28]) and more rapid recovery (SMD = -1.06, with 95%CI [-1.83, -0.28]). Current evidences also indicated that the differences of various adverse effects between two groups were not significant.ConclusionsGiven that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future.Trial registrationThe protocol of present study was registered with PROSPERO (CRD42022321348).

【 授权许可】

CC BY   
© The Author(s) 2022

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