Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis
Background: Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. Methods: The study protocol was registered in PROSPERO as...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421003158 |
| _version_ | 1797786564493836288 |
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| author | Get..lio Rodrigues de Oliveira Filho Carlos Maestri Castilhos Jean Philippe Kriegl Giulia Nonticuri Bianchi |
| author_facet | Get..lio Rodrigues de Oliveira Filho Carlos Maestri Castilhos Jean Philippe Kriegl Giulia Nonticuri Bianchi |
| author_sort | Get..lio Rodrigues de Oliveira Filho |
| collection | DOAJ |
| description | Background: Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. Methods: The study protocol was registered in PROSPERO as CRD42020172920. A systematic literature search was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing oral combinations of midazolam and ketamine with midazolam alone as preanesthetic medication in elective surgical pediatric patients. Meta-analyses included the following outcomes: anxiety and sedation levels, child...s behavior during separation from parents, face mask acceptance, and venipuncture. The quality of evidence was assessed using GRADE criteria. Results: Twenty studies were included. The following effects (RR (95% CI)) were observed for combinations of ketamine and midazolam relative midazolam alone: anxiolysis (1.2 (0.94...1.52); p.ß=.ß0.15; I2.ß=.ß80%; GRADE.ß=.ßvery low); satisfactory sedation (1.2 ( 1.10...1.31); p.ß<.ß0.001; I2.ß=.ß71%; GRADE.ß=.ßvery low); behavior during parental separation (1.2 (1.06...1.36); p.ß=.ß0.003; I2.ß=.ß88%; GRADE.ß=.ßvery low); facial mask acceptance (1.13 (1.04...1.24); p.ß=.ß0.007; I2.ß=.ß49%; GRADE.ß=.ßvery low); behavior during venipuncture (1.32 (1.11...1.57); p.ß=.ß0.002; I2.ß=.ß66%; GRADE.ß=.ßvery low). Conclusions: While similar probabilities of obtaining anxiolysis were found, adequate sedation, calm behavior during child...s separation from parents, low levels of fear during face mask adaptation, and cooperative behavior during peripheral venous cannulation were more likely with midazolam-ketamine combinations. |
| first_indexed | 2024-03-13T01:10:36Z |
| format | Article |
| id | doaj.art-5b5412827f9a4304b3df097ee2fe9c68 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-03-13T01:10:36Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-5b5412827f9a4304b3df097ee2fe9c682023-07-06T04:16:55ZengElsevierBrazilian Journal of Anesthesiology0104-00142023-07-01734477490Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysisGet..lio Rodrigues de Oliveira Filho0Carlos Maestri Castilhos1Jean Philippe Kriegl2Giulia Nonticuri Bianchi3Corresponding author.; Universidade Federal de Santa Catarina, Departamento de Cirurgia, Florian..polis, SC, BrazilUniversidade Federal de Santa Catarina, Departamento de Cirurgia, Florian..polis, SC, BrazilUniversidade Federal de Santa Catarina, Departamento de Cirurgia, Florian..polis, SC, BrazilUniversidade Federal de Santa Catarina, Departamento de Cirurgia, Florian..polis, SC, BrazilBackground: Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. Methods: The study protocol was registered in PROSPERO as CRD42020172920. A systematic literature search was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing oral combinations of midazolam and ketamine with midazolam alone as preanesthetic medication in elective surgical pediatric patients. Meta-analyses included the following outcomes: anxiety and sedation levels, child...s behavior during separation from parents, face mask acceptance, and venipuncture. The quality of evidence was assessed using GRADE criteria. Results: Twenty studies were included. The following effects (RR (95% CI)) were observed for combinations of ketamine and midazolam relative midazolam alone: anxiolysis (1.2 (0.94...1.52); p.ß=.ß0.15; I2.ß=.ß80%; GRADE.ß=.ßvery low); satisfactory sedation (1.2 ( 1.10...1.31); p.ß<.ß0.001; I2.ß=.ß71%; GRADE.ß=.ßvery low); behavior during parental separation (1.2 (1.06...1.36); p.ß=.ß0.003; I2.ß=.ß88%; GRADE.ß=.ßvery low); facial mask acceptance (1.13 (1.04...1.24); p.ß=.ß0.007; I2.ß=.ß49%; GRADE.ß=.ßvery low); behavior during venipuncture (1.32 (1.11...1.57); p.ß=.ß0.002; I2.ß=.ß66%; GRADE.ß=.ßvery low). Conclusions: While similar probabilities of obtaining anxiolysis were found, adequate sedation, calm behavior during child...s separation from parents, low levels of fear during face mask adaptation, and cooperative behavior during peripheral venous cannulation were more likely with midazolam-ketamine combinations.http://www.sciencedirect.com/science/article/pii/S0104001421003158Medication, preanestheticChildPediatrics, surgeryCyclohexanes, ketamineBenzodiazepines, midazolam |
| spellingShingle | Get..lio Rodrigues de Oliveira Filho Carlos Maestri Castilhos Jean Philippe Kriegl Giulia Nonticuri Bianchi Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis Brazilian Journal of Anesthesiology Medication, preanesthetic Child Pediatrics, surgery Cyclohexanes, ketamine Benzodiazepines, midazolam |
| title | Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis |
| title_full | Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis |
| title_fullStr | Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis |
| title_full_unstemmed | Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis |
| title_short | Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis |
| title_sort | oral preanesthetic medication in children comparison between midazolam alone and in combination with ketamine a systematic review and meta analysis |
| topic | Medication, preanesthetic Child Pediatrics, surgery Cyclohexanes, ketamine Benzodiazepines, midazolam |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421003158 |
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