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Safety and efficacy of dexmedetomidine for flexible bronchoscopy: A systematic review and meta-analysis
Amna Hassni, Abdul Hannan Siddiqui, Mahdeem Shahid, Abia Shariq, Huma Anwar, Khizra Nadeem, Alina Anjum, Hamida Memon, Ameer Talha, Sarosh Khan, Yusra Faisal, Maheen Naveed, Abdul Moeed, Salim Surani
Amna Hassni, Abdul Hannan Siddiqui, Mahdeem Shahid, Abia Shariq, Huma Anwar, Hamida Memon, Sarosh Khan, Yusra Faisal, Maheen Naveed, Abdul Moeed, Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Khizra Nadeem, Department of Internal Medicine, Jinnah Sindh Medical University, Karachi 75510, Sindh, Pakistan
Alina Anjum, Ameer Talha, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan
Salim Surani, Department of Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
Author contributions: Hassni A, Shahid M and Shariq A participated in the conceptualization, data curation, and writing of the original draft; Siddiqui AH and Moeed A participated in the supervision, validation, visualization, and writing review and editing; Anwar H, Nadeem K, Anjum A, Memon H, Talha A, Khan S, Faisal Y and Naveed M participated in the investigation, methodology, project administration, resources, and writing of the original draft; Surani S approved the concept, supervised, reviewed and edited the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Abdul Hannan Siddiqui, Researcher, Department of Internal Medicine, Dow University of Health Sciences, Mission Road, Karachi 74200, Sindh, Pakistan.
abdul.siddiqui19@dmc.duhs.edu.pk
Received: August 6, 2025
Revised: September 26, 2025
Accepted: December 26, 2025
Published online: March 18, 2026
Processing time: 216 Days and 15.7 Hours
BACKGROUND
Dexmedetomidine (DEX) is a drug that is specifically an agonist for the alpha-2 adrenergic receptor, which has been explored for potential use in the provision of anesthesia during flexible bronchoscopy. Tactical mechanisms enable DEX to be able to provide sedation without marked respiratory depression hence aiding patients with poor respiratory reserve.
AIM
To investigate the safety and efficacy of DEX by examining heart rate, blood pressure, oxygen saturation, patient satisfaction and adverse effects.
METHODS
A meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across PubMed, Scopus, and the Cochrane Library. Randomized controlled trials comparing DEX with other sedatives (midazolam, remimazolam, propofol) during bronchoscopy were included. Primary outcomes were mean heart rate, mean oxygen saturation, and patient discomfort. Secondary outcomes included Ramsay Sedation Score, cough, pain and distress, ease of bronchoscopy, quality of sedation, composite scores, and adverse effects. A random-effects model was used for analysis.
RESULTS
Fourteen randomized controlled trials involving 1920 patients were finalized. Patients using DEX had a higher mean oxygen saturation throughout the procedure (P < 0.0003, I² = 18%) and a decreased mean heart rate (P < 0.00001, I² = 22%). Additionally, DEX significantly increased the incidence of bradycardia (P = 0.00001, I² = 53%). The results show no difference in discomfort experienced by the patients when compared to the control groups.
CONCLUSION
Results show DEX to have a significant risk of bradycardia and hypotension. The effect on patient satisfaction was indeterminate; larger trials are required to confirm long-term safety and efficacy.
Core Tip: This meta-analysis assessed the effectiveness of dexmedetomidine (DEX), a selective alpha-2 adrenergic receptor agonist, as a sedative agent in flexible bronchoscopy. Compared with other sedative and analgesic regimens, DEX notably reduced the risk of hypoxemia and tachycardia, while mildly improving patient and physician satisfaction. Although extra sedation was administered where necessary, the overall safety profiles were favorable. These findings suggest that DEX is a promising option for patients with compromised respiratory capacity, providing enhanced safety and tolerability during bronchoscopy.
