Preoperative Use of Midazolam vs Dexmedetomidine for Anxiolysis in Day-Care Surgery

Year : 2026 | Volume : 16 | Issue : 01 | Page : 7 12
    By

    Pratul,

  • Masrata Gull,

  • Deepanshu Sharma,

  • Javid Ahmadvani,

  1. Student, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Haryana, India
  2. Student, Department of Rediology, Dolphin PG College, Chunni Kalan, Punjab, India
  3. Assistant Professor, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Haryana, India
  4. Assistant Professor, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Haryana, India

Abstract

Surgical procedures trigger significant fear and anxiety that can adversely affect physiological responses and recovery outcomes. This prospective, randomized, double-blinded clinical trial compared the anxiolytic efficacy and safety of intravenous midazolam and dexmedetomidine in 60 patients undergoing day-care surgery. Primary outcomes included anxiety scores measured by STAI and sedation assessed by the OAAS scale at multiple perioperative time points. Secondary outcomes assessed in the study included detailed evaluation of hemodynamic parameters, such as heart rate, systolic, and diastolic blood pressure, mean arterial pressure, and overall cardiovascular stability, along with the incidence and nature of drug-related side effects. Both dexmedetomidine and midazolam were found to be effective in achieving adequate anxiolysis and improving patient comfort during the procedure. However, notable differences were observed in their safety profiles. Dexmedetomidine was more frequently associated with hemodynamic alterations, particularly episodes of bradycardia and hypotension, likely attributable to its central sympatholytic action. In contrast, patients receiving midazolam demonstrated a comparatively stable cardiovascular profile but experienced a higher incidence of adverse effects, such as nausea and vomiting. These findings indicate that while both agents are clinically effective for anxiety reduction, the selection of an appropriate sedative should be individualized, taking into consideration the patient’s baseline cardiovascular status, susceptibility to adverse effects, procedural requirements, and overall risk profile to optimize safety and therapeutic outcomes.

Keywords: Anxiety, anxiolysis, day-care surgery, dexmedetomidine, midazolam, sedation

[This article belongs to Research and Reviews: A Journal of Medicine ]

How to cite this article:
Pratul, Masrata Gull, Deepanshu Sharma, Javid Ahmadvani. Preoperative Use of Midazolam vs Dexmedetomidine for Anxiolysis in Day-Care Surgery. Research and Reviews: A Journal of Medicine. 2026; 16(01):7-12.
How to cite this URL:
Pratul, Masrata Gull, Deepanshu Sharma, Javid Ahmadvani. Preoperative Use of Midazolam vs Dexmedetomidine for Anxiolysis in Day-Care Surgery. Research and Reviews: A Journal of Medicine. 2026; 16(01):7-12. Available from: https://journals.stmjournals.com/rrjom/article=2026/view=239707


References

  1. Pasin L, Febres D, Testa V, Frati E, Borghi G, Landoni G, et al. Dexmedetomidine vs midazolam as preanesthetic medication in children: A meta-analysis of randomized controlled trials. Paediatr Anaesth. 2015;25(5):468–76. doi:10.1111/pan.12587.
  2. Du Z, Zhang XY, Qu SQ, Song ZB, Wei SW, Xiang Z, et al. The comparison of dexmedetomidine and midazolam premedication on postoperative anxiety in children undergoing hernia repair surgery: A randomized controlled trial. Paediatr Anaesth. 2019;29(8):843–9. PMID:31125470.
  3. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine versus midazolam for sedation of critically ill patients: A randomized trial. JAMA. 2009;301(5):489–99. doi:10.1001/jama.2009.56.
  4. Jen CK, Lu KC, Chen KW, Lu YR, Huang IT, Huang YC, et al. Efficacy and safety of dexmedetomidine compared to other sedation methods in pediatric imaging procedures: A systematic review and meta-analysis. J Clin Med. 2024;13(4):1174. doi:10.3390/jcm13041174.
  5. Pasin L, Febres D, Testa V, Frati E, Borghi G, Landoni G, et al. Dexmedetomidine vs midazolam meta-analysis. Paediatr Anaesth. 2015;25(5):468–76.
  6. Peng K, Wu SR, Ji FH, Li J. Premedication with dexmedetomidine in pediatric patients: Systematic review and meta-analysis. Clinics (Sao Paulo). 2014;69(11):777–786. doi:10.6061/clinics/2014(11)12. PMID:25518037; PMCID:PMC4255070.
  7. Mustafa MS, Shafique MA, Zaidi SDEZ, Qamber A, Rangwala BS, Ahmed A, et al. Preoperative anxiety management in pediatric patients: A systematic review and meta-analysis. Front Pediatr. 2024;12:1353508. doi:10.3389/fped.2024.1353508.
  8. Effectiveness and safety of intranasal dexmedetomidine versus midazolam for sedation of pediatric patients: A systematic review with trial sequential analysis. J Pediatr Surg. 2025;[epub ahead of print].
  9. Shebl MA, Toraih E, Shebl M, Tolba AM, Ahmed P, Banga HS, et al. Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. J Clin Transl Sci. 2025;17(91):e33. doi:10.1017/cts.2025.e33.
  10. Gu X, Zhang Y, Wei W, Zhu J. Effects of preoperative anxiety on postoperative outcomes and sleep quality in patients undergoing laparoscopic gynecological surgery. J Clin Med. 2023;12(5):1835. doi:10.3390/jcm12051835.
  11. Abate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. Int J Surg Open. 2020;25:6–16. doi:10.1016/j.ijso.2020.05.010.
  12. Wang X, Xu J, Li G, Zhang Y, Chen L. Clinical trial of dexmedetomidine premedication in pediatric anesthesia: Effects on sedation and perioperative outcomes. Paediatr Anaesth. 2020;30(10):1082–1089. doi:10.1111/pan.14012.
  13. Duan S, Zhang Y, Li X, Chen J, Wang L. Dexmedetomidine versus midazolam in pediatric anesthesia: Comparative randomized controlled trial. Anesth Analg. 2019;129(3):776–783.
  14. Duan Q, Li Y, Zhang H, Wang L. Perioperative dexmedetomidine use in pediatric patients: A systematic review and meta-analysis. J Anesth Clin Res. 2018;9(789):1–7.
  15. Pereira B, Nascimento TSD, da Costa MG, Slawka E, Júnior CG. Dexmedetomidine vs midazolam sedation effectiveness: A prospective comparative study. Front Pediatr. 2024;12:940812. doi:10.3389/fped.2024.940812.
  16. Dalal PD, Yaddanapudi S, Sharma SM, Lakshmy R, Diwan S. Comparison of oral dexmedetomidine and oral midazolam as premedication in pediatric patients: A randomized double-blind clinical trial. Paediatr Anaesth. 2018;28(6):525–531. doi:10.1111/pan.13359.
  17. Hu Z, Xiang H, Zeng Z, Wu J, Liu L, Tang J, Long M, Wang M. Efficacy and safety of different preoperative sedative regimens in alleviating pediatric preoperative anxiety: A systematic review and network meta-analysis. Anesthesiol Perioper Sci. 2025;18(3):e70068. doi:10.1111/jebm.70068.
Regular Issue Subscription Original Research
Volume 16
Issue 01
Received 14/11/2025
Accepted 13/01/2026
Published 28/02/2026
Publication Time 106 Days
18

Login


My IP

PlumX Metrics