Related Experiment Video

Updated: May 19, 2026

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery
09:47

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Published on: June 2, 2022

Dexmedetomidine Versus Midazolam as a Primary Sedative Agent in Critically Ill Pediatrics

Khalid W Taher1,2, Mayas Alnan2,3, Rahaf Yaseen2

  • 1Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

The Annals of Pharmacotherapy
|May 18, 2026
PubMed

Insights

Dexmedetomidine and midazolam are comparable sedative options for pediatric intensive care unit patients. Dexmedetomidine may reduce the need for additional sedatives and analgesics, offering a potential alternative.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Anesthesiology

Background:

  • Dexmedetomidine is recommended for postoperative sedation in critically ill pediatric patients.
  • National guidelines for its use as a primary sedative in the pediatric intensive care unit (PICU) are lacking.

Purpose of the Study:

  • To compare the efficacy and safety of dexmedetomidine versus midazolam as primary sedative agents in pediatric patients.
  • To evaluate outcomes including PICU length of stay, duration of mechanical ventilation, and need for additional agents.

Main Methods:

  • Single-center retrospective chart review of 190 pediatric patients (1 month to 14 years) in the PICU.
  • Patients received either dexmedetomidine or midazolam as their primary sedative while mechanically ventilated.
  • Primary outcomes: PICU length of stay and mechanical ventilation duration. Secondary outcomes: need for additional sedatives/analgesics, sedation goal achievement, and adverse events (hypotension, bradycardia, arrhythmia).

Main Results:

  • No statistically significant differences in PICU length of stay or mechanical ventilation duration between dexmedetomidine and midazolam groups.
  • Patients receiving midazolam required more additional sedatives and analgesics.
  • Sedation goal achievement was not significantly different, and no safety outcome differences were observed.

Conclusions:

  • Dexmedetomidine and midazolam demonstrate comparable efficacy and safety in sedating pediatric ICU patients.
  • Dexmedetomidine is a viable alternative to midazolam, particularly when minimizing exposure to additional sedatives and opioids is desired.
Abstract

Keywords:
continuous infusiondexmedetomidinemidazolampediatricssedatives

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A key...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...