title: Dexmedetomidine versus midazolam for gastrointestinal endoscopy: a meta-analysis.
abstract: OBJECTIVE
  Patients who undergo gastrointestinal endoscopy often require sedatives such as midazolam and the more recently developed alpha-2 agonist, dexmedetomidine. To assess the efficacy and safety of dexmedetomidine sedation for gastrointestinal endoscopy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing dexmedetomidine with midazolam.
  
  
  METHODS
  We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database in order to identify randomized trials eligible for inclusion in our meta-analysis. Data from the eligible studies were combined to calculate pooled odds ratios (OR) or weighted mean differences (WMD).
  
  
  RESULTS
  We identified nine randomized trials from the database search. Compared to that of midazolam, the pooled OR for restlessness of dexmedetomidine was 0.078 (95% confidence interval [CI]: 0.013-0.453, P < 0.0001), and there was no significant heterogeneity among the trial results. Dexmedetomidine significantly increased Ramsay sedation score compared with midazolam (WMD: 0.401, 95% CI: 0.110-0.692, P = 0.0069), without significant heterogeneity. Compared with midazolam, the pooled OR for hypoxia, hypotension, and bradycardia with dexmedetomidine sedation were 0.454 (95% CI: 0.098-2.11), 1.370 (95% CI: 0.516-3.637), and 2.575 (95% CI: 0.978-6.785), respectively, with no significant differences detected between the groups.
  
  
  CONCLUSIONS
  This meta-analysis shows that dexmedetomidine is a safe and effective sedative agent for gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection.
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nishizawa
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Seiji
authors.initials: S
authors.lastname: Sagara
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000494:pharmacology*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008874:Midazolam / Q000494:pharmacology*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam
keywords: dexmedetomidine; endoscopy; meta-analysis; midazolam; sedative agent