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Objectives: To evaluate the impact of preoperative midazolam administration on patients’ perioperative neurocognitive disorders through a meta-analysis. Methods: Search the PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine disc, and VIP Database. The search time ranges from the establishment of each database to the present. Randomized controlled trials exploring the influence of preoperative midazolam application on perioperative cognitive function are included. The primary outcome indicator is the incidence of postoperative delirium, and the secondary outcome indicators are the anxiety status of patients before surgery after intervention and the scores of perioperative cognitive-related assessment scales. The selection of literature, extraction of data, and assessment of literature quality are all independently carried out by two researchers. In case of disputes, a third-party researcher will be invited for re-evaluation. The quality of the selected literature is evaluated based on the Cochrane Risk of Bias Assessment Tool. Statistical analysis is performed using RevMan 5.3 and Stata 16.0 software. Trial sequential analysis is conducted using TSA 0.9.5.10 Beta software. Results: A total of 20 articles were finally included, involving 2544 patients in total. Among them, 1355 patients were in the preoperative midazolam group and 1189 patients were in the placebo group. The meta-analysis results showed that preoperative administration of midazolam could significantly reduce the incidence of pediatric postoperative delirium (POD). Subgroup analysis indicated that oral administration of midazolam at a dose of 0.75 mg/kg 30 minutes before surgery had a better effect. Preoperative use of midazolam may be beneficial in reducing the incidence of POD in adults. Preoperative application of midazolam could significantly reduce the anxiety level of patients before surgery after the intervention. In the cognitive-related fields, preoperative midazolam administration may cause short-term residual impairment or delayed recovery of information processing speed and executive function in patients assessed before surgery after drug administration, preoperative midazolam administration may not result in significant short-term improvements or rapid recovery of information processing speed and executive function in postoperative patients. Conclusions: Preoperative administration of midazolam can reduce the incidence of POD and relieve preoperative anxiety. It may causes short-term residual impairment or delayed recovery of information processing speed and executive function in patients before surgery after drug administration, and may not lead to significant short-term improvement or rapid recovery of information processing speed and executive function in postoperative patients.
Liu et al. (Thu,) studied this question.