Dexmedetomidine Versus Midazolam In Patients Planned For Complex Digestive Endoscopy:A Meta-analysis Of Randomized Controlled Trials

Objective: In the study,we compared dexmedetomidine with midazolam to assess the efficacy and safety of dexmedetomidine sedation for complex digestive endoscopy.Methods: We searched literatures in the following databases: PubMed,Embase,the Cochrane Library,VIP,CNKI and Wanfang,up to November,2019,for RCTs in which the patients used dexmedetomidine and midazolam during the complex digestive endoscopy therapy.Two researchers screened the titles and abstracts according to inclusion and exclusion criteria.The main outcomes include: respiratory depression,hypoxemia.The second outcomes include: cough,gagging,body movement,vomiting,hypotension,bradycardia,recovery time,and satisfaction of patients and operators.The quality of the included articles was evaluated by the Cochrane standard evaluation method and Jadad rating scale.The data analysis was performed by using Rev Man 5.2,Stata 12.0 software,R software and TSA software.Results: 17 literatures were included for meta-analysis,with a total sample size of totaling 1298 cases.The meta-analysis results showed that dexmedetomidine decreased the risk of respiratory depression(RR=0.23,95%CI: 0.09-0.51;P<0.01),hypoxemia(RR=0.21,95%CI: 0.06-0.78;P=0.15),cough(RR=0.25,95%CI: 0.14-0.44;P<0.01),body movement(RR=0.17,95%CI: 0.10-0.28;P<0.01)and vomiting(RR=0.55,95%CI: 0.33-0.87;P=0.01).Patients and doctors were more satisfied with dexmedetomidine(SMD=0.72,95%CI: 0.26-1.19;P=0.01),(SMD=0.83,95%CI:0.24-1.42;P<0.01).There were no statistically significant difference on hypotension(RR=1.46,95%CI: 0.85-2.87;P=0.15)and similar time for the patients to recover(SMD=0.07,95%CI:-0.10-0.54;P=0.07)..However,it is noteworthy that increased the risk of bradycardia(RR=5.25,95%CI: 2.80-17.52;P<0.01).Conclusion: Our analysis shows that dexmedetomidine can be safely used in complex digestive endoscopic therapy with lower incidence of respiratory depression and hypoxemia.However,dexmedetomidine has a higher risk of bradycardia,prolonged recovery time.Compared with midazolam.A large multi-center sample study is needed to further explore the benefits and risks of dexmedetomidine in complex digestive endoscopy.