Comparison of safety and efficacy of commonly used sedatives in bronchoscopy examination: a Bayesian network meta-analysis of randomized controlled trials.

Abstract

Introduction: Propofol, dexmedetomidine, midazolam, and remimazolam are widely used for sedation during bronchoscopy. The purpose of this network meta-analysis was to compare the safety and efficacy of these four sedative drugs for bronchoscopy.

Evidence acquisition: PubMed, Embase, Cochrane Libary, and Wed of Science databases were systematically searched to collect randomized controlled trials (RCTs) of propofol, dexmedetomidine, midazolam, and remimazolam for bronchoscopy from the inception of the database to December 25, 2023. The search strategy we used was (sedative subject terms or sedative free terms) AND (bronchoscopy subject terms or bronchoscopy free terms), without language restrictions. The included studies were randomized controlled trials. Two authors independently searched the databases, selected studies, and extracted data.

Evidence synthesis: Eleven RCTs and 1,076 patients were finally included. The results showed that in terms of hypoxemia, compared to midazolam (RR=0.156, 95% CI [0.031, 0.677]), placebo (RR=1.109, 95% Cl [0.014, 0.977]), propofol (RR=0.112, 95% Cl [0.021, 0.553]), and remimazolam (RR=0.104, 95% Cl [0.012, 0.991]), dexmedetomidine significantly reduced the occurrence of hypoxemia (P<0.05). A surface under the cumulative ranking curve (SUCRA) value indicated a higher ranking of a treatment plan, suggesting that the treatment plan is more advantageous. In terms of hypoxemia, the SUCRA ranking was as follows: dexmedetomidine (98%) > midazolam (57%) > placebo (33%) > remimazolam (32%) > propofol (30%). In terms of arrhythmia, the SUCRA ranking was as follows: dexmedetomidine (89%) > placebo (44%) > remimazolam (42%) > midazolam (40%) > propofol (35%). In terms of bronchoscopy time, the SUCRA ranking was as follows: propofol (68%) > remimazolam (67%) > midazolam (66%) > dexmedetomidine (37%) > placebo (12%).

Conclusions: Compared to midazolam, remimazolam, and propofol, dexmedetomidine significantly reduced the occurrence of hypoxemia and arrhythmia during bronchoscopy. Additionally, bronchoscopy procedures performed under propofol sedation exhibited the shortest operating time.