Maternal and Neonatal Outcomes With the Addition of Intrathecal Midazolam as an Adjuvant to Spinal Anesthesia in Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

(J Clin Anesth. 2022;80:110786 | https://doi.org/10.1016/j.jclinane.2022.110786.) In 2015, global cesarean deliveries (CD) reached 29.7 million. While evidence indicates comparable outcomes between general and regional anesthesia, the latter is preferred for elective CD due to benefits like reduced fetal exposure to anesthetics. Intrathecal bupivacaine is effective but can cause adverse effects like hypotension. Low-dose bupivacaine minimizes risks but may require additional analgesics, potentially leading to general anesthesia. Various adjuvants, such as opioids and alpha-2-agonists, enhance spinal anesthesia quality, each with unique effects. Intrathecal midazolam, studied since the 1980s, has shown promise in reducing nausea and vomiting. However, its safety for neonates and effectiveness in cesarean delivery remained uncertain. This systematic review and meta-analysis aimed to fill this gap by comprehensively assessing the efficacy and safety of adding intrathecal midazolam to spinal anesthesia for CD in healthy pregnant patients, considering maternal and neonatal outcomes.