Cochrane · systematic review · CD009491
Midazolam for sedation before procedures
Conway, A, Rolley, J, Sutherland, JR · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Emergency and Critical CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
17
No studies
17
Included studies
NR
No studies 17 · 48.6%Ungraded 1 · 2.9%Very low 5 · 14.3%Low 6 · 17.1%Moderate 6 · 17.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Intravenous midazolam compared to diazepam for sedation before procedures
Population: adults and children requiring sedation before gastrointestinal endoscopy and bronchoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Level of sedation on a sedation assessment scale Intravenous midazolam vs diazepam | no estimate extracted | 1 study · 75 participants | Very low Downgraded: risk of bias, imprecision |
Numeric rating of anxiety or rated as anxious Intravenous midazolam vs diazepam | RR 0.8 [0.39, 1.62] | 2 studies · 175 participants | Low Downgraded: risk of bias, imprecision |
Incomplete procedure Intravenous midazolam vs diazepam | no estimate extracted | 1 study · 170 participants | Ungraded |
Anterograde amnesia (defined by number of participants who recalled the procedure) Intravenous midazolam vs diazepam | RR 0.45 [0.3, 0.66] | 9 studies · 587 participants | Low Downgraded: risk of bias, inconsistency |
Disinhibition or excitation Intravenous midazolam vs diazepam | no estimate extracted | NR | No studies |
Discomfort/pain Intravenous midazolam vs diazepam | RR 0.6 [0.24, 1.49] | 5 studies · 415 participants | Low Downgraded: risk of bias, imprecision |
Allergic or anaphylactoid reaction Intravenous midazolam vs diazepam | no estimate extracted | NR | No studies |
Intravenous midazolam compared to placebo for sedation before procedures
Population: adults requiring sedation before gastrointestinal endoscopy and bronchoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Level of sedation on a sedation assessment scale Intravenous midazolam vs placebo | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Numeric rating of anxiety or rated as anxious Intravenous midazolam vs placebo | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias, imprecision |
Incomplete procedures Intravenous midazolam vs placebo | no estimate extracted | NR | No studies |
Anterograde amnesia (defined by number of participants who recalled the procedure) Intravenous midazolam vs placebo | no estimate extracted | NR | No studies |
Disinhibition or excitation Intravenous midazolam vs placebo | no estimate extracted | NR | No studies |
Discomfort/pain Intravenous midazolam vs placebo | no estimate extracted | 1 study · 167 participants | Very low Downgraded: risk of bias, imprecision |
Allergic or anaphylactoid reaction Intravenous midazolam vs placebo | no estimate extracted | NR | No studies |
Oral midazolam compared to chloral hydrate for sedation before procedures
Population: children requiring sedation before procedures that require motion control, including echocardiography, lumbar puncture, micturating cystourethrograms and neuroimaging
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Level of sedation on sedation assessment scale Oral midazolam vs chloral hydrate | no estimate extracted | 1 study · 160 participants | Moderate Downgraded: risk of bias |
Numeric rating of anxiety or rated as anxious Oral midazolam vs chloral hydrate | no estimate extracted | 2 studies · 88 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Incomplete procedures Oral midazolam vs chloral hydrate | RR 4.01 [1.92, 8.4] | 4 studies · 268 participants | Moderate Downgraded: risk of bias |
Anterograde amnesia (defined by number of participants who recalled the procedure) Oral midazolam vs chloral hydrate | no estimate extracted | NR | No studies |
Disinhibition or excitation Oral midazolam vs chloral hydrate | no estimate extracted | NR | No studies |
Discomfort Oral midazolam vs chloral hydrate | no estimate extracted | NR | No studies |
Allergic or anaphylactoid reaction Oral midazolam vs chloral hydrate | no estimate extracted | NR | No studies |
Oral midazolam compared to placebo for sedation before procedures
Population: children requiring sedation before micturating cystourethrograms and Kirschner wire removal and adults undergoing flexible sigmoidoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Level of sedation on a sedation assessment scale Oral midazolam vs placebo | no estimate extracted | 1 study · 99 participants | Moderate Downgraded: risk of bias |
Numeric rating of anxiety or rated as anxious Oral midazolam vs placebo | no estimate extracted | 3 studies · 176 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Incomplete procedure Oral midazolam vs placebo | no estimate extracted | 3 studies · 179 participants | Very low Downgraded: risk of bias, imprecision |
Anterograde amnesia (defined by number of participants who recalled the procedure) Oral midazolam vs placebo | no estimate extracted | NR | No studies |
Disinhibition or excitation Oral midazolam vs placebo | no estimate extracted | NR | No studies |
Discomfort/Pain Oral midazolam vs placebo | no estimate extracted | 1 study · 99 participants | Moderate Downgraded: risk of bias |
Allergic or anaphylactoid reaction Oral midazolam vs placebo | no estimate extracted | NR | No studies |
Intranasal midazolam compared to placebo for sedation before procedures
Population: Children requiring sedation before voiding cystourethrograms and adults undergoing MRI
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Level of sedation on a sedation assessment scale Intranasal midazolam vs placebo | no estimate extracted | 1 study · 54 participants | Moderate Downgraded: risk of bias |
Numeric rating of anxiety or rated as anxious Intranasal midazolam vs placebo | no estimate extracted | 1 study · 54 participants | Moderate Downgraded: risk of bias |
Incomplete procedure Intranasal midazolam vs placebo | RR 0.14 [0.02, 1.12] | 2 studies · 149 participants | Low Downgraded: risk of bias, imprecision |
Anterograde amnesia (defined by number of participants who recalled the procedure) Intranasal midazolam vs placebo | no estimate extracted | NR | No studies |
Disinhibition or excitation Intranasal midazolam vs placebo | no estimate extracted | NR | No studies |
Discomfort/pain Intranasal midazolam vs placebo | no estimate extracted | NR | No studies |
Allergic or anaphylactoid reaction Intranasal midazolam vs placebo | no estimate extracted | NR | No studies |