title: Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.
abstract: OBJECTIVE
  To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation.
  
  
  METHODS
  We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Exclusion criteria: patients in intensive care, pediatric subjects and per protocol use of additional sedative medication other than rescue medication. Outcome measures for efficacy comparison were patient and clinician satisfaction scores and pain scores; outcome measures for safety comparison were hypotension, hypoxia, and circulatory and respiratory complications.
  
  
  RESULTS
  We identified 89 papers, of which 12 satisfied the inclusion and exclusion criteria; 883 patients were included in these studies. Dexmedetomidine was associated with higher patient and operator satisfaction than midazolam. Patients receiving dexmedetomidine experienced less pain and had lower analgesic requirements. Respiratory and hemodynamic safety were similar.
  
  
  CONCLUSIONS
  Dexmedetomidine is a promising alternative to midazolam for use in procedural sedation. Dexmedetomidine provides more comfort during the procedure for the patient and clinician. If carefully titrated, the safety profiles are similar.
authors.affiliation: Department of Anesthesiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Clemens R M
authors.initials: CR
authors.lastname: Barends
authors.affiliation: Department of Anesthesiology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Anthony
authors.initials: A
authors.lastname: Absalom
authors.affiliation: Department of oral and maxillofacial surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Baucke
authors.initials: B
authors.lastname: van Minnen
authors.affiliation: Department of oral and maxillofacial surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of oral and maxillofacial surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Visser
mesh_terms: D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D012119:Respiration / Q000187:drug effects
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam