Dexmedetomidine vs. midazolam-fentanyl for intraoperative analgesia and sedation: a systematic review and meta analysis

Background Ongoing research aims to identify the most effective sedative for procedural sedation. This meta-analysis compares dexmedetomidine with midazolam-fentanyl in surgical patients. Methods We conducted a search through MEDLINE, EMBASE and CENTERAL to find randomized controlled trials (RCTs) comparing dexmedetomidine and midazolam-fentanyl. Data on participant characteristics, intervention details, and outcomes were extracted, focusing on intraoperative hemodynamic parameters, respiratory safety, and adverse events. Sedative efficacy and recovery profiles were also evaluated and assessed descriptively across included studies. Data were analyzed using RevMan 5.4, applying random effects models for significant heterogeneity (I 2 > 50%). Studies with fewer than three data points per group were excluded, and sensitivity analyses were performed. Results We include 4 RCTs with 259 patients. Dexmedetomidine significantly lowered mean arterial pressure (MAP) by −6.42 mmHg (95% CI: −8.24 to −2.21, p < 0.001). Initially, heart rate differences were not significant, but after excluding an outlier, dexmedetomidine reduced heart rates by 6.71 bpm (95% CI: −10.74 to −2.68, p = 0.001). Respiratory rate and oxygen saturation showed no significant differences between groups, and adverse events were comparable. Conclusion Dexmedetomidine offers superior blood pressure control compared to midazolam-fentanyl, with similar safety profiles for respiratory parameters. Further research is needed to assess long-term outcomes such as postoperative delirium and residual sedation.