Efficacy of melatonin vs. midazolam for oral premedication in children: a systematic review and meta-analysis
Abstract
INTRODUCTION
Achieving appropriate levels of premedication and parental separation is needed for smooth induction of anesthesia and prevention of perioperative complications. Both melatonin and midazolam are used for the premedication in children, but we do not have consensus on which premedication is superior among them.
EVIDENCE ACQUISITION
A systematic review of randomized controlled trials comparing the efficacy and safety of use of midazolam and melatonin as premedication in children aged 1-15 years was conducted. Patients who received drugs other than melatonin or midazolam as premedication were excluded. PubMed, Embase, Scopus, Google Scholar were searched and the last search was done in December 2022.
EVIDENCE SYNTHESIS
Full text of ten articles with a total of 774 participants (442 melatonin, 332 midazolam) were eligible. The data extracted were synthesized after quality assessment. The outcomes appraised included: sedation, anxiety in preoperative room and during induction. Among four studies examining sedation, there were no significant differences between melatonin and midazolam (SMD=0.03, 95% CI - 0.35 to 0.40, P=0.88, I2=81%). There were no significant differences between melatonin and midazolam among two studies examining anxiety in pre-operative room (SMD=-0.04, 95% CI -4.58,4.50, P=0.99, I2=0%) and anxiety during anesthesia induction as an outcome (SMD=-1.38, 95% CI -4.81 to 2.05, P=0.43, I2=0%).
CONCLUSIONS
The review showed that melatonin is comparable to…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 774 participants or records.
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