Midazolam for sedation before procedures

Aaron Conway, John ROLLEY, Joanna R. Sutherland

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

Review question: We wanted to find out whether midazolam makes medical procedures more comfortable for children and adults, as well as whether it makes the procedure easier to perform. Background: Children and adults can become anxious during medical procedures and the procedures can be painful. Pain and anxiety can sometimes make the procedure more difficult to perform for the medical staff, due to movement or a lack of co-operation from the patient. Sedative medications, including midazolam, are used to reduce pain and anxiety. They can be injected directly into the bloodstream (with an almost immediate effect), injected into muscle tissue, given as a nasal spray, or swallowed as a tablet or solution. Study characteristics: The evidence is up-to-date to January 2016. We included 30 trials involving 2319 participants. We looked at trials that compared midazolam with no active treatment ('dummy' treatment/placebo) or a different medication for sedation before a procedure. The trials involved children and adults having procedures to diagnose medical problems rather than procedures for treatment of a disease. We disregarded trials where people received a general anaesthetic or other medications for sedation or pain relief in addition to midazolam during their procedure. Key results: Midazolam administered into the bloodstream compared with other medications did not seem to make the participants more drowsy, reduce anxiety or pain, or make the procedure easier to perform. This is based on the low-quality evidence currently available. A potential benefit is that children and adults who received midazolam compared with no active treatment did not remember as much about the procedures. Midazolam made them drowsy, reduced anxiety and made it easier to perform a procedure. There is moderate-quality evidence that a solution of midazolam given to children to drink before a procedure was not as effective as a different medication called chloral hydrate. A nasal spray of midazolam before a procedure made the participants drowsy and reduced their anxiety, but this did not make it easier to perform procedures on them. This review cannot be used to assess the harms of midazolam for sedation before a procedure. Quality of the evidence: We rated the evidence, in the main, as being of low quality. Particularly concerning was that many trials did not explain how participants were randomized to either midazolam or to a different treatment, and that the results did not give us a very clearly defined answer.
Authors' conclusions: We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.
Original languageEnglish
Pages (from-to)1-3
Number of pages3
JournalCochrane Database of Systematic Reviews
Volume2016
Issue number5
DOIs
Publication statusPublished - 20 May 2016
Externally publishedYes

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Midazolam
Anxiety
Placebos
Chloral Hydrate
Nasal Sprays
Pain
Hypnotics and Sedatives
Therapeutics
General Anesthetics

Cite this

Conway, Aaron ; ROLLEY, John ; Sutherland, Joanna R. / Midazolam for sedation before procedures. In: Cochrane Database of Systematic Reviews. 2016 ; Vol. 2016, No. 5. pp. 1-3.
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abstract = "Review question: We wanted to find out whether midazolam makes medical procedures more comfortable for children and adults, as well as whether it makes the procedure easier to perform. Background: Children and adults can become anxious during medical procedures and the procedures can be painful. Pain and anxiety can sometimes make the procedure more difficult to perform for the medical staff, due to movement or a lack of co-operation from the patient. Sedative medications, including midazolam, are used to reduce pain and anxiety. They can be injected directly into the bloodstream (with an almost immediate effect), injected into muscle tissue, given as a nasal spray, or swallowed as a tablet or solution. Study characteristics: The evidence is up-to-date to January 2016. We included 30 trials involving 2319 participants. We looked at trials that compared midazolam with no active treatment ('dummy' treatment/placebo) or a different medication for sedation before a procedure. The trials involved children and adults having procedures to diagnose medical problems rather than procedures for treatment of a disease. We disregarded trials where people received a general anaesthetic or other medications for sedation or pain relief in addition to midazolam during their procedure. Key results: Midazolam administered into the bloodstream compared with other medications did not seem to make the participants more drowsy, reduce anxiety or pain, or make the procedure easier to perform. This is based on the low-quality evidence currently available. A potential benefit is that children and adults who received midazolam compared with no active treatment did not remember as much about the procedures. Midazolam made them drowsy, reduced anxiety and made it easier to perform a procedure. There is moderate-quality evidence that a solution of midazolam given to children to drink before a procedure was not as effective as a different medication called chloral hydrate. A nasal spray of midazolam before a procedure made the participants drowsy and reduced their anxiety, but this did not make it easier to perform procedures on them. This review cannot be used to assess the harms of midazolam for sedation before a procedure. Quality of the evidence: We rated the evidence, in the main, as being of low quality. Particularly concerning was that many trials did not explain how participants were randomized to either midazolam or to a different treatment, and that the results did not give us a very clearly defined answer. Authors' conclusions: We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.",
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Midazolam for sedation before procedures. / Conway, Aaron; ROLLEY, John; Sutherland, Joanna R.

In: Cochrane Database of Systematic Reviews, Vol. 2016, No. 5, 20.05.2016, p. 1-3.

Research output: Contribution to journalReview article

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T1 - Midazolam for sedation before procedures

AU - Conway, Aaron

AU - ROLLEY, John

AU - Sutherland, Joanna R.

PY - 2016/5/20

Y1 - 2016/5/20

N2 - Review question: We wanted to find out whether midazolam makes medical procedures more comfortable for children and adults, as well as whether it makes the procedure easier to perform. Background: Children and adults can become anxious during medical procedures and the procedures can be painful. Pain and anxiety can sometimes make the procedure more difficult to perform for the medical staff, due to movement or a lack of co-operation from the patient. Sedative medications, including midazolam, are used to reduce pain and anxiety. They can be injected directly into the bloodstream (with an almost immediate effect), injected into muscle tissue, given as a nasal spray, or swallowed as a tablet or solution. Study characteristics: The evidence is up-to-date to January 2016. We included 30 trials involving 2319 participants. We looked at trials that compared midazolam with no active treatment ('dummy' treatment/placebo) or a different medication for sedation before a procedure. The trials involved children and adults having procedures to diagnose medical problems rather than procedures for treatment of a disease. We disregarded trials where people received a general anaesthetic or other medications for sedation or pain relief in addition to midazolam during their procedure. Key results: Midazolam administered into the bloodstream compared with other medications did not seem to make the participants more drowsy, reduce anxiety or pain, or make the procedure easier to perform. This is based on the low-quality evidence currently available. A potential benefit is that children and adults who received midazolam compared with no active treatment did not remember as much about the procedures. Midazolam made them drowsy, reduced anxiety and made it easier to perform a procedure. There is moderate-quality evidence that a solution of midazolam given to children to drink before a procedure was not as effective as a different medication called chloral hydrate. A nasal spray of midazolam before a procedure made the participants drowsy and reduced their anxiety, but this did not make it easier to perform procedures on them. This review cannot be used to assess the harms of midazolam for sedation before a procedure. Quality of the evidence: We rated the evidence, in the main, as being of low quality. Particularly concerning was that many trials did not explain how participants were randomized to either midazolam or to a different treatment, and that the results did not give us a very clearly defined answer. Authors' conclusions: We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.

AB - Review question: We wanted to find out whether midazolam makes medical procedures more comfortable for children and adults, as well as whether it makes the procedure easier to perform. Background: Children and adults can become anxious during medical procedures and the procedures can be painful. Pain and anxiety can sometimes make the procedure more difficult to perform for the medical staff, due to movement or a lack of co-operation from the patient. Sedative medications, including midazolam, are used to reduce pain and anxiety. They can be injected directly into the bloodstream (with an almost immediate effect), injected into muscle tissue, given as a nasal spray, or swallowed as a tablet or solution. Study characteristics: The evidence is up-to-date to January 2016. We included 30 trials involving 2319 participants. We looked at trials that compared midazolam with no active treatment ('dummy' treatment/placebo) or a different medication for sedation before a procedure. The trials involved children and adults having procedures to diagnose medical problems rather than procedures for treatment of a disease. We disregarded trials where people received a general anaesthetic or other medications for sedation or pain relief in addition to midazolam during their procedure. Key results: Midazolam administered into the bloodstream compared with other medications did not seem to make the participants more drowsy, reduce anxiety or pain, or make the procedure easier to perform. This is based on the low-quality evidence currently available. A potential benefit is that children and adults who received midazolam compared with no active treatment did not remember as much about the procedures. Midazolam made them drowsy, reduced anxiety and made it easier to perform a procedure. There is moderate-quality evidence that a solution of midazolam given to children to drink before a procedure was not as effective as a different medication called chloral hydrate. A nasal spray of midazolam before a procedure made the participants drowsy and reduced their anxiety, but this did not make it easier to perform procedures on them. This review cannot be used to assess the harms of midazolam for sedation before a procedure. Quality of the evidence: We rated the evidence, in the main, as being of low quality. Particularly concerning was that many trials did not explain how participants were randomized to either midazolam or to a different treatment, and that the results did not give us a very clearly defined answer. Authors' conclusions: We found no high-quality evidence to determine if midazolam, when administered as the sole sedative agent prior to a procedure, produces more or less effective sedation than placebo or other medications. There is low-quality evidence that intravenous midazolam reduced anxiety when compared with placebo. There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo. Intranasal midazolam did not reduce the risk of incomplete procedures, although anxiolysis and sedation were observed. There is moderate-quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures.

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