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Safety of oral midazolam sedation use in paediatric dentistry: a review

BACKGROUND: Little information is available as to the safety of midazolam when used as an oral sedative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Comparison of the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury: a meta-analysis

OBJECTIVE: To perform a meta-analysis to compare the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Is dexmedetomidine superior to midazolam as a premedication in children? A meta-analysis of randomized controlled trials

BACKGROUND: In the current published literature, there are controversial results regarding the effectiveness of dexmedetomidine compared with midazolam as premedication in children. The aim of this meta-analysis was to compare the use of dexmedetomidine as a premedication in pediatric patients with that of midazolam.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review

This review concluded that midazolam and propofol were equally safe and effective for procedural sedation of adults in the emergency department, and that use of one agent over the other should be guided by resource utilisation and treatment costs. The authors’ conclusions appeared to reflect the evidence, but the limitations with the included studies should be borne in mind.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children?

The review examined whether premedication with oral midazolam in children undergoing general anaesthesia improved behavioural outcomes. It concluded that 0.5 mg/kg oral premedication with midazolam, 20 to 30 minutes preoperatively, was effective in reducing separation and induction anxiety in children, with minimal effect on recovery times. Poor review methodology and reporting means that the reliability of this conclusion is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Use of intrathecal midazolam to improve perioperative analgesia: a meta-analysis

The authors concluded that limited data suggested that adding midazolam to other intrathecal agents could safely reduce perioperative nausea, vomiting and pain during caesarean delivery, but further safety data is required. While the review was generally well-conducted and the conclusion reflected the evidence, it was unclear why caesarean delivery was highlighted when no analysis was conducted for this specific group.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

[Rapid tranquillisation: review of the literature and recommendations]

BACKGROUND: In The Netherlands, no guidelines exist for rapid tranquillisation in the context of acute agitation, excitement or aggression secondary to a psychiatric disorder.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

[Haloperidol plus promethazine for agitated patients - a systematic review]

OBJECTIVE: Rapid and safe tranquillisation is sometimes unavoidable. We conducted this systematic review to determine the value of the combination haloperidol plus promethazine, frequently used in Brazil.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Sedation in Children and Young People: Sedation for Diagnostic and Therapeutic Procedures in Children and Young People [Internet]

Many children present to hospitals and dental clinics needing effective sedation or anaesthesia for painful or distressing diagnostic or therapeutic procedures. There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources are required to deliver them safely. Sedation is not always effective enough and will occasionally require the procedure to be delayed until the child can be anaesthetised perhaps in another healthcare setting or on another day. Consequently sedation failure is both distressing for the child and has major NHS cost implications. Excessive doses of sedation can cause unintended loss of consciousness and dangerous hypoxia. In comparison, planned anaesthesia is effective, but may have resource implications. The need for sedation or anaesthesia will depend upon the type of procedure. Some types of procedures are very common and healthcare providers and practitioners need to understand whether sedation or anaesthesia is the most cost effective method of managing them

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2010
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A systematic review of interventions for reducing pain and distress in children undergoing voiding cystourethrography

This review concluded that conscious sedation with midazolam alleviated the distress of voiding cystourethrography in children older than one year. Psychological preparation and warmed contrast medium may be effective. Nitrous oxide required further evidence. The evidence base was small and the quality of the evidence was sometimes unclear. The conclusions did not reflect the findings accurately and therefore may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Sedation and analgesia for pediatric fracture reduction in the emergency department: a systematic review

The review concluded that ketamine hydrochloride-midazolam hydrochloride was associated with less distress and significantly fewer airway interventions during paediatric fracture reduction than fentanyl citrate-midazolam or propofol-fentanyl. Data comparing other forms of sedation or analgesia were limited. The authors' conclusions reflect the evidence presented, but their reliability is uncertain due to potential language bias and small sample sizes for some studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition

These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care.

World Health Organization.

Version: 2016
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Propofol versus traditional sedative agents for gastrointestinal endoscopy: a meta-analysis

This review compared the complication rates of propofol with traditional sedative agents used during gastrointestinal endoscopy. The authors concluded that the risk of cardiopulmonary complications appeared lower during colonoscopy, but there was no difference in complications for other endoscopic procedures. The authors' conclusions should be treated with caution as their results only pertain to hypoxia and hypotension, not all cardiopulmonary complications.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review

This study found that dexmedetomidine may be effective in reducing intensive care unit (ICU) length of stay and time to extubation in critically ill ICU patients. Evidence on the use of clonidine in ICU is very limited. Large, well-designed clinical trials are needed to evaluate the long-term effects of clonidine for sedation in ICU and to identify subgroups of patients who are more likely to benefit from dexmedetomidine.

Health Technology Assessment - NIHR Journals Library.

Version: March 2016
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Sedation and Anesthesia Options for Diagnostic Procedures: A Review of Clinical Effectiveness and Guidelines [Internet]

The purpose of this rapid review was to assess the available evidence regarding the clinical effectiveness of sedation and/or anesthesia options in patients undergoing diagnostic procedures who are required to be still. Furthermore, guidelines on sedation and anesthesia in patients undergoing diagnostic procedures were identified and assessed.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 8, 2015
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Dexmedetomidine for Sedation in the ICU or PICU: A Review of Cost-Effectiveness and Guidelines [Internet]

Sedation of ICU patients is often essential for ICU patients to maximize survival, reduce ICU and hospital stay, and facilitate mechanical ventilation. The standard of care for sedation includes benzodiazepine sedatives and propofol. These sedatives (notably benzodiazepines) are associated with an increased risk of agitation and delirium. It has been hypothesized that dexmedetomidine would be an appropriate alternative to traditional sedatives for maintaining light to moderate sedation. Dexmedetomidine is an alpha2-adrenergic agonist, and it is approved in Canada for intensive care unit sedation and conscious sedation. In January 2014, the Canadian Agency for Drugs and Technologies in Health (CADTH) reviewed the evidence on the clinical effectiveness of using dexmedetomidine for sedation in intensive-care unit. Based on the CADTH review, dexmedetomidine was found to be associated with decreased ICU stay and decreased time on mechanical ventilation. However, it was associated with higher rates of bradycardia than comparators.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: December 17, 2014
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Routine echocardiography in the management of stroke and transient ischaemic attack: a systematic review and economic evaluation

Study found that, transthoracic echocardiography in second harmonic imaging mode is a cost-effective use of NHS resources in those cases where clinicians deem it the most appropriate method of testing to identify cardiac sources of stroke and transient ischaemic attack. However, the study highlights that there is a lack of evidence in several areas and the results of the economic evaluation should be treated with caution.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014
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Intravenous Ketamine for the Treatment of Mental Health Disorders: A Review of Clinical Effectiveness and Guidelines [Internet]

Ketamine emerged as a novel treatment for certain mental health disorders in 2000 when Berman et al. published a seven patient RCT of intravenous (IV) ketamine compared to a saline placebo showing a reduction in the Hamilton Depression Rating Scale (Ham-D). This was the first suggestion that ketamine could be a benefit for treating mental health disorder and since previous investigations on treatment of mental health disorders have focused on the monoamines (dopamine, norepinephrine and serotonin) this approach may have great potential. Current psychiatric guidelines for treatment of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation do not include statements regarding the use of ketamine however research continues to be published.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 20, 2014
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The Epilepsies: The Diagnosis and Management of the Epilepsies in Adults and Children in Primary and Secondary Care: Pharmacological Update of Clinical Guideline 20

This guideline is a partial update of ‘The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care’ (NICE clinical guideline 20, 2004). It updates the pharmacological management sections of the 2004 guideline and also includes the use of the ketogenic diet.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2012
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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