{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T07:36:13Z","timestamp":1774596973555,"version":"3.50.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ongoing research aims to identify the most effective sedative for procedural sedation. This meta-analysis compares dexmedetomidine with midazolam-fentanyl in surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:sup>2<\/jats:sup>\n                      \u2009&amp;gt;\u200950%). Studies with fewer than three data points per group were excluded, and sensitivity analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We include 4 RCTs with 259 patients. Dexmedetomidine significantly lowered mean arterial pressure (MAP) by \u22126.42\u2005mmHg (95% CI: \u22128.24 to \u22122.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Initially, heart rate differences were not significant, but after excluding an outlier, dexmedetomidine reduced heart rates by 6.71\u2005bpm (95% CI: \u221210.74 to \u22122.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Respiratory rate and oxygen saturation showed no significant differences between groups, and adverse events were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpain.2026.1664460","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:39:39Z","timestamp":1774593579000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dexmedetomidine vs. midazolam-fentanyl for intraoperative analgesia and sedation: a systematic review and meta analysis"],"prefix":"10.3389","volume":"7","author":[{"given":"Hashim Talib","family":"Hashim","sequence":"first","affiliation":[{"name":"College of Medicine, University of Warith Al-Anbiyaa","place":["Karbala, Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mostafa A.","family":"Khalifa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Cairo University","place":["Cairo, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aya Ahmed","family":"Shimal","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Baghdad","place":["Baghdad, Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marafi Jammaa","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Bahri University","place":["Khartoum, Sudan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed H.","family":"Elbadawi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Khartoum","place":["Khartoum, Sudan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadeeja Ali","family":"Hamzah","sequence":"additional","affiliation":[{"name":"Baghdad University AIkindy College of Medicine","place":["Baghdad, Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulhadi M. A.","family":"Mahgoub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Gezira","place":["Madani, Gezira, Sudan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alaa R.","family":"AL-Ihribat","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Polytechnic University","place":["Hebron, Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salem Waleed Salem","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Alexandria University","place":["Alexandria, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fathima Raahima Riyas","family":"Mohamed","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elian","family":"Khalafalla","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Khartoum","place":["Khartoum, Sudan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna","family":"Kamil","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University","place":["Karachi, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anzah Imtiaz","family":"Wagga","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University","place":["Karachi, Pakistan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Mohamed","family":"Shahin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Menoufia University","place":["Menoufia, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelrhman H.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"College of Medicine, Luxor University","place":["Luxor, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1093\/bja\/aet194","article-title":"Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients: a systematic review","volume":"111","author":"Adams","year":"2013","journal-title":"Br J Anaesth"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0169525","DOI":"10.1371\/journal.pone.0169525","article-title":"Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety","volume":"12","author":"Barends","year":"2017","journal-title":"PLoS One"},{"key":"B3","doi-asserted-by":"publisher","first-page":"367","DOI":"10.4103\/0970-9185.83684","article-title":"Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation","volume":"27","author":"Eren","year":"2011","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e66","DOI":"10.1097\/PCC.0000000000000599","article-title":"Efficacy of \u03b12-agonists for sedation in pediatric critical care","volume":"17","author":"Hayden","year":"2016","journal-title":"Pediatr Crit Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"197","DOI":"10.21037\/atm.2019.04.14","article-title":"Dexmedetomidine versus midazolam and propofol for sedation in critically ill patients: mining the medical information mart for intensive care data","volume":"7","author":"Song","year":"2019","journal-title":"Ann Transl Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/s00134-008-1296-0","article-title":"Dexmedetomidine versus propofol\/midazolam for long-term sedation during mechanical ventilation","volume":"35","author":"Ruokonen","year":"2009","journal-title":"Intensive Care Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s13054-015-0787-y","article-title":"Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation","volume":"19","author":"Turunen","year":"2015","journal-title":"Critical Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"7507","DOI":"10.2147\/JIR.S346089","article-title":"Recent advances in the clinical value and potential of dexmedetomidine","volume":"14","author":"Liu","year":"2021","journal-title":"J Inflamm Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1001\/jama.2012.304","article-title":"Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation","volume":"307","author":"Jakob","year":"2012","journal-title":"JAMA"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e0294292","DOI":"10.1371\/journal.pone.0294292","article-title":"A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: a systematic review and meta-analysis","volume":"18","author":"Wen","year":"2023","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Br Med J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"173","DOI":"10.4103\/0970-9185.111671","article-title":"A prospective randomized double-blind study comparing dexmedetomidine vs. Combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care","volume":"29","author":"Parikh","year":"2013","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.21608\/ejhm.2021.168267","article-title":"Comparative study between dexmedetomidine vs midazolam-fentanyl on emergence agitation in children undergoing cochlear implantation in sohag university hospital","volume":"83","author":"Hashem","year":"2021","journal-title":"Egypt J Hosp Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1017\/S0265021508004699","article-title":"Dexmedetomidine causes prolonged recovery when compared with midazolam\/fentanyl combination in outpatient shock wave lithotripsy","volume":"25","author":"Zeyneloglu","year":"2008","journal-title":"Eur J Anaesthesiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1111\/j.1399-6576.1994.tb03881.x","article-title":"Intramuscular dexmedetomidine premedication\u2014an alternative to midazolam-fentanyl-combination in elective hysterectomy?","volume":"38","author":"Jaakola","year":"1994","journal-title":"Acta Anaesthesiol Scand"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e135276","DOI":"10.5812\/aapm-135276","article-title":"Dexmedetomidine vs. Fentanyl-midazolam combination to mitigate the stress response in microlaryngoscopy","volume":"13","author":"Oriby","year":"2023","journal-title":"Anesthesiol Pain Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s40262-017-0507-7","article-title":"Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine.","volume":"56","author":"Weerink","year":"2017","journal-title":"Clin Pharmacokinet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1097\/00000542-198503000-00017","article-title":"Midazolam: pharmacology and uses.","volume":"62","author":"Reves","year":"1985","journal-title":"Anesthesiology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00000542-200008000-00016","article-title":"The effects of increasing plasma concentrations of dexmedetomidine in humans.","volume":"93","author":"Ebert","year":"2000","journal-title":"Anesthesiology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s00134-022-06712-2","article-title":"Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials.","volume":"48","author":"Lewis","year":"2022","journal-title":"Intensive Care Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"109736","DOI":"10.1016\/j.jclinane.2020.109736","article-title":"Dexmedetomidine versus other sedatives for non-painful pediatric examinations: a systematic review and meta-analysis of randomized controlled trials.","volume":"62","author":"Lin","year":"2020","journal-title":"J Clin Anesth"},{"key":"B22","first-page":"e10","article-title":"Dexmedetomidine-Fentanyl versus midazolam-fentanyl in pain management of distal radius fractures reduction; a randomized clinical trial.","volume":"6","author":"Arhami Dolatabadi","year":"2018","journal-title":"Emergency (Tehran, Iran)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1177\/106002809002400707","article-title":"Possible intramuscular midazolam-associated cardiorespiratory arrest and death.","volume":"24","author":"Taylor","year":"1990","journal-title":"DICP"}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2026.1664460\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:39:41Z","timestamp":1774593581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2026.1664460\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":23,"alternative-id":["10.3389\/fpain.2026.1664460"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2026.1664460","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"article-number":"1664460"}}