Fig: Mechanism of action of Midazolam
It was searched for studies published up to May 2014 in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the Institute for Scientific Information (ISI), Web of Science, and reference lists of publications published up to May 2014. To look for unpublished research, we contacted pharmaceutical companies and examined databases such as the Science Citation Index, ClinicalTrials.gov, and the Current Controlled Trials for relevant information. The linguistic requirements for our participants were not specified ahead of time. In May 2015, we re-ran the search and uncovered nine new papers that we believe should be investigated in greater depth. When we amend the review, we will take new research into consideration.
In order to be considered for the study, the researchers had to compare Dexmeditomidine to a placebo or another medication commonly used during abdominal surgery in adults. Participants who required ”rescue” analgesia, postoperative sedation, PONV, time to first flatus and stool passage, and time to first out-of-bed mobilization were also evaluated in the trials.
Following the screening of the titles and abstracts for eligibility, the data was individually assessed for relevance by two review authors, who worked in parallel. Using a data collecting form, all relevant information from the studies included was retrieved, and the risk of bias was assessed. We were able to work out our differences with the third reviewer. As part of the risk of bias assessment and data extraction process, we contacted research authors or, where applicable, co-authors from current or previous studies to obtain additional information relevant to their work.
The following are the most important findings: There were a total of 492 participants in the seven studies that were included in our systematic review. The total number of participants in our study is 422 people. Over a dozen queries are still being treated as classified. With the exception of one study (80 participants) that discovered an increase in postoperative pain, six studies involving 402 participants compared Dexmeditomidine to placebo and discovered a reduction in ”rescue” opioid consumption in the first 24 hours after surgery, but no clinically significant differences in postoperative pain (as measured by a VAS ranging from 0 to 100 mm, with 100 being the worst possible pain). Because of the high heterogeneity that results from pooling data, statistical meta-analyses were deemed inappropriate in this case. Because of a lack of precision and the risk of bias, the evidence for our major outcomes was of extremely low quality, as was the evidence for our minor outcomes. A scarcity of evidence, as well as estimations that were either erroneous or of poor methodological quality, undermined our secondary aims.
The data on the comparison of Dexmeditomidine and fentanyl were insufficient to draw any definitive conclusions (one study, 20 participants).
The following are the authors’ main conclusions: It appeared to have some opioid sparing effects when Dexmeditomidine was given preoperatively to treat acute pain following abdominal surgery in adults, but it had no detectable effect on postoperative pain when compared to a placebo. Several factors contributed to the poor quality of the evidence, including typographical errors, methodological limitations, and a high degree of heterogeneity across the seven studies that were included. In part due to the fact that the effect of Dexmeditomidine on crucial patient outcomes such as gastrointestinal function, mobilization, and side effects could not be fully evaluated, the drug’s clinical utility for patients is currently unknown. Because all of the included studies were too small to be taken into account, there was no way to rule out publication bias completely. The data was confined to middle-aged individuals who were in good health and were receiving elective abdominal surgery at the time of the study. Although a considerable quantity of data from trials containing combination surgery was not available, it is possible that this contributed to a potential bias in the results. A higher number of studies with longer follow-up periods are required in order to uncover and evaluate patient-important outcomes.