Safety and efficacy of dexmedetomidine for flexible bronchoscopy: A systematic review and meta-analysis

Table 1 Study characteristics, n (%)

Ref.	Study design	Population	Intervention	Control	Sample size		Males		Study duration	DEX dose	Route of administration	Purpose of bronchoscopy
					Intervention	Control	Intervention	Control
Magazine et al[27], 2024	RCT	Patients aged 18-65 years undergoing FB in a tertiary care hospital in South India	DEX (0.75 μg/kg)	Midazolam -fentanyl (0.035 mg/kg and 25 μg)	31	31	18 (58)	20 (64.5)	41 months	0.75 µg/kg	Intravenous infusion	To visualize the bronchial tree and perform necessary sampling procedures
Zhou et al[21], 2024	RCT	Patients aged 18-70 undergoing painless flexible fiberoptic bronchoscopy	DEX (4 μg/mL) -remifentanil (20 μg/mL)	Remimazolam (1 mg/mL) -remifentanil (20 μg/mL)	182	182	116 (63.7)	126 (69.2)	18 months	4 μg/mL	Intravenous infusion	Evaluation of unexplained cough, hemoptysis, localized wheezing, hoarseness, suspected lung abnormalities, lung disease evaluation, and preoperative assessment
Magazine et al[28], 2021	RCT	Patients (aged 18-65, requiring diagnostic FB)	DEX (0.75 μg/kg)	Midazolam (0.035 mg/kg)	24	24	13 (54.2)	10 (41.7)	17 months	0.75 µg/kg	Intravenous infusion	Diagnostic
Kim et al[29], 2021	RCT	Patients undergoing EBUS-TBNA	DEX (0.25-0.75 μg/kg)	Midazolam	48	54	33 (68.8)	39 (72.2)	14 months	0.25-0.75 μg/kg	Intravenous infusions	Diagnostic
Zhang et al[31], 2021	RCT	Patients undergoing bronchoscopy	DEX combined with midazolam	Fentanyl combined with midazolam	222	211	139 (62.6)	126 (59.7)	-	-	Intravenous infusion	Diagnostic
Magazine et al[30], 2020	RCT	Patients aged 18-65 requiring diagnostic FB	DEX (0.5 μg/kg)	Midazolam (0.035 mg/kg)	27	27	19 (70.4)	14 (51.9)	22 months	0.5 μg/kg	Intravenous infusion	Diagnostic bronchoscopy to evaluate pulmonary pathologies, assess centrally located tumors, and identify the cause of hemoptysis
Goneppanavar et al[32], 2015	RCT	Patients aged 18-70 years undergoing FB	DEX (1 μg/kg)	Midazolam (0.02 mg/kg)	27	27	20 (74.1)	24 (88.9)	-	1 μg/kg	Intravenous infusion	Evaluation of the airway in the Department of Pulmonary Medicine
Liao et al[33], 2012	RCT	Postoperative adult patients in the intensive care unit who had undergone thoracic surgery and were referred for bronchoscopy	DEX	Midazolam	99	99	61 (61.6)	62 (63.3)	12 months	-	Intravenous infusion	Postoperative evaluation in patients who had undergone thoracic surgery
Kumari et al[34], 2021	RCT	Patients undergoing EBUS-TBNA	DEX (1 μg/kg)	Midazolam (2 mg/kg)	99	98	56 (56.6)	50 (51)	-	1 μg/kg	Intravenous infusion	To perform EBUS-TBNA for diagnostic evaluation
Riachy et al[22], 2018	RCT	Patients aged 18-70 undergoing elective FB	DEX (0.5 μg/kg)	Alfentanil (10 μg/kg)	53	55	31 (58.5)	30 (55.6)	25 months	0.5 μg/kg	Intravenous infusion	Diagnostic evaluation of pulmonary disease
Yuan et al[23], 2016	RCT	Patients aged 20-75 years with ASA I-III undergoing elective FB	DEX (1 μg/kg) + fentanyl (1 μg/kg)	Propofol (4 μg/mL) + fentanyl (1 μg/kg)	50	50	27 (54)	22 (44)	6 months	1 μg/kg	Intravenous infusion	Various procedures (e.g., bronchoalveolar lavage, transbronchial biopsy)
Shoukry et al[24], 2016	RCT	Adult patients (18-70 years old, ASA I-III) undergoing elective fiberoptic bronchoscopy	DEX (1 μg/kg) + fentanyl (1 μg/kg)	Propofol (0.5-1 mg/kg) + fentanyl (1 µg/kg)	36	36	23 (63.9)	25 (69.4)	9 months	1 μg/kg	Intravenous infusion	Diagnostic purposes (e.g., lung cancer staging, hemoptysis, interstitial lung disease)
Mani et al[26], 2015	RCT	Patients undergoing FB	DEX (1 μg/kg)	Propofol (1 mg/kg)	30	30	-	-	-	1 μg/kg	Intravenous infusion	Diagnostic FB
Ryu et al[25], 2012	RCT	Patients, aged 18-70 years, ASA I-III, undergoing elective diagnostic FB	DEX (0.4-2 μg/kg) + propofol (0.5 mg/kg)	Propofol (0.5 mg/kg) + remifentanil (1-5 μg/kg)	35	35	20 (57)	18 (51)	7 months	0.4-2 μg/kg	Intravenous infusion	Diagnostic FB

ASA: American Society of Anesthesiologists; DEX: Dexmedetomidine; EBUS-TBNA: Endobronchial ultrasound-guided transbronchial needle aspiration; FB: Flexible bronchoscopy; RCT: Randomized controlled trial.

Table 2 Baseline patient characteristics, mean ± SD/ mean (95%CI)

Ref.	Age (year)		Weight (kg)			Body mass index (kg/m²)			Duration of bronchoscopy		Heart rate (bpm)		Mean systolic blood pressure (mmHg)		Mean diastolic blood pressure (mmHg)		Mean oxygen saturation, saturation of oxygen in blood
	Intervention	Control	Intervention	Control		Intervention	Control		Intervention	Control	Intervention	Control	Intervention	Control	Intervention	Control	Intervention	Control
Magazine et al[27], 2024	47.65 ± 13.41	50.23 ± 11.97	52.94 ± 12.36	57.16 ± 10.95		20.90 ± 4.86	21.83 ± 3.19		15.35 ± 11.93	12.84 ± 8.11	89.87 ± 11.35	85.94 ± 16.86	133.77 ± 22.38	124.68 ± 14.16	83.29 ± 8.77	76.61 ± 9.31	99.45 ± 1.50	99.23 ± 1.28
Magazine et al[28], 2021	48.50 ± 13.138	44.42 ± 12.047	50.55 ± 10.20	50.07 ± 7.81		20.25 ± 2.80	20.05 ± 3.36		13.42 ± 6.801	10.54 ± 3.706	81.92 ± 18.533	84.83 ± 15.670	127.42 ± 20.930	126.58 ± 20.905	74.08 ± 11.088	78.92 ± 9.528	99.92 ± 0.408	100.00 ± 0.000
Kim et al[29], 2021	63.7 ± 11.3	63.9 ± 11.0	-	-		23.4 ± 2.9	23.7 ± 2.6		-	-	-	-	-	-	-	-	-	-
Zhang et al[31], 2021	58.03 ± 14.04	60.23 ± 11.56	63.40 ± 11.60	61.76 ± 9.72		-	-		24.40 ± 12.37	20.29 ± 10.96	-	-	-	-	-	-	-	-
Magazine et al[30], 2020	47.07 ± 13.40	45.00 ± 14.26	53.23 ± 8.69	50.37 ± 9.84		20.61 ± 3.27	19.98 ± 3.51		-	-	87.85 ± 16.19	87.41 ± 16.31	131.63 ± 22.56	126.67 ± 18.92	77.85 ± 9.53	77.19 ± 11.49	100.00 ± 0	99.85 ± 0.53
Goneppanavar et al[32], 2015	49.70 ± 13.85	52.52 ± 15.05	53.26 ± 10.10	56.07 ± 10.84		20.77 ± 3.40	20.42 ± 3.46		8.93 ± 2.96	8.19 ± 2.53	-	-	-	-	-	-	-	-
Liao et al[33], 2012	58.5 ± 9.1	60.1 ± 8.4	57.0 ± 8.4	58.2 ± 11.3		-	-		12.8 ± 2.6	13.1 ± 2.6	-	-	-	-	-	-	-	-
Kumari et al[34], 2021	44 ± 14	49 ± 14	63 ± 13	65 ± 13		-	-		-	-	-	-	-	-	-	-	-	-
Zhou et al[21], 2024	61 (55-65)	60 (52-66)	60 (53-68)	61 (54-70)		22.24 ± 2.787	22.60 ± 2.742		13 (10-18.5)	13 (10-19)	-	-	-	-	-	-	-	-
Riachy et al[22], 2018	63		-	-		-	-		16		-	-	-	-	-	-	-	-
Yuan et al[23], 2016	59.76 ± 7.61	60.46 ± 69.3	-	-		22.20 ± 3.06	21.69 ± 3.16		20.64 ± 2.08	21.14 ± 1.87	-	-	-	-	-	-	-	-
Shoukry et al[24], 2016	50.3 ± 14.9	47.9 ± 15.3	77.9 ± 14.2	80.3 ± 14.0		-	-		21.8 ± 3.9	21.5 ± 3.6	-	-	-	-	-	-	-	-
Mani et al[26], 2015	-	-	164.9			61.3 ± 6.15			-	-	-	-	-	-	-	-	-	-
Ryu et al[25], 2012	52.9 (27-67)	52.9 (23-69)	62.1 ± 13.8		60.6 ± 13.8	-		-	12.1 ± 2.8	12.0 ± 3.4	-	-	-	-	-	-	-	-