Date of this Version


Document Type

DNP Project


Background: When patients need a surgical procedure, the natural reaction is to have a heightened sense of anxiety. This anxiety can be regarded as an unwanted response, as it can affect the patient’s perception of the procedure and how pain is experienced. In children, the fear of the unknown and the new can be a traumatizing event in their lives; therefore, it should be considered how practitioners help handle this anxiety and apprehension. Medications such as midazolam and dexmedetomidine are used to help modify this emotion.

Aim: This systematic review aims to investigate the potential benefits of using dexmedetomidine intranasally instead of midazolam to help cope with this preoperative sedation and postoperative emergence in the pediatric population. An education module was also deployed to help improve the current knowledge of certified nurse anesthetists working within the pediatric population.

Results: All 10 studies were randomized controlled trials (RCT) with a minimum level 1C appraisal designation according to the Johns Hopkins research evidence appraisal tool.11 A total of 828 children were selected for these trials in all parts of the world. The ages ranged from 2-14 years old. Four of the RCTs used comparable levels of sedation compared to the 10 studies when comparing dexmedetomidine and midazolam. Six of the remaining RCTs had better results regarding sedation levels and were recommended by the authors. The statistical analysis between the pre-test and post-test of the education module showed an increase in provider knowledge.

Discussion: The results from 10 RCTs demonstrate that dexmedetomidine is indeed a better preoperative medication for sedation and has the added benefit of analgesic properties to help postoperatively. The drawback is the cost difference when compared to midazolam. The other potential downside is the onset of action time is slower with dexmedetomidine versus midazolam in reaching optimal sedation levels.

Conclusion: The studies' results have been consistent and clear that dexmedetomidine is superior to midazolam for preoperative sedation and postoperative analgesia. The use of dexmedetomidine can help curb unwanted side effects as well such as respiratory depression with midazolam. The movement to change this common practice of midazolam should be done with the sole focus of improving patient experiences and outcomes.