Safety and Efficacy of Dexmedetomidine for Bronchoscopy: A Systematic Review and Meta-Analysis

Guo, Qianqian; An, Q.; Zhao, Liuyang; Wu, Meng; Wang, Ye; Guo, Zhenggang

doi:10.3390/jcm12041607

Cited by 4 publications

(1 citation statement)

References 34 publications

(100 reference statements)

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“…Sedative medications such as propofol are commonly used in a variety of medical settings, including diagnostic, surgical, and other therapeutic procedures, as well as anesthetic induction and critical care ( Ghojazadeh et al, 2019 ; Freitas et al, 2022 ; Guo et al, 2023 ). Despite the ability of sedatives to provide relief from procedure-related anxiety and discomfort through the induction of sedation and anxiolysis, safety concerns remain an important issue as they can cause varying degrees of depression in the respiratory and cardiovascular systems as well as a loss of airway reflexes ( Godoroja-Diarto et al, 2022 ; Sneyd et al, 2022 ; Hara et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation

Hung,

Chen,

et al. 2023

Front. Pharmacol.

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Background: Ciprofol (HSK3486) is a novel intravenous anesthetic agent that bears structural similarity to propofol and displays favorable pharmacodynamic characteristics such as rapid onset and offset. The meta-analysis aimed at comparing the efficacy and safety of ciprofol versus propofol in clinical practice.Methods: Medline, EMBASE, Google Scholar, Cochrane Library were searched from inception to April 2023. The primary outcome was success rate of sedation/anesthetic induction and differences in sedation/induction time. The secondary outcomes included risks of hemodynamic instability, respiratory complications, and pain on injection, as well as recovery profiles, satisfaction score, and top-up dose requirement.Results: Twelve RCTs (sedation: n = 6, anesthetic induction, n = 6, all conducted in China) involving 1,793 patients (age: 34–58 years) published from 2021 to 2023 were analyzed. Pooled results revealed no differences in success rate [risk ratio (RR) = 1, 95% confidence interval (CI): 0.99 to 1.01, I2 = 0%, 1,106 patients, p = 1] and time required for successful anesthetic induction/sedation [mean difference (MD) = 7.95 s, 95% CI: −1.09 to 16.99, I2 = 97%, 1,594 patients, p = 0.08]. The risks of top-up dose requirement (RR = 0.94, p = 0.48), cardiopulmonary complications [i.e., bradycardia (RR = 0.94, p = 0.67), tachycardia (RR = 0.83, p = 0.68), hypertension (RR = 1.28, p = 0.2), hypoxemia/pulmonary depression (RR = 0.78, p = 0.24)], and postoperative nausea/vomiting (RR = 0.85, p = 0.72), as well as discharge time (MD = 1.39 min, p = 0.14) and satisfaction score (standardized MD = 0.23, p = 0.16) did not differ significantly between the two groups. However, the ciprofol group had lower risks of hypotension (RR = 0.85, p = 0.02) and pain on injection (RR = 0.17, p < 0.00001) than the propofol group. The time to full alertness was statistically shorter in the propofol group (i.e., 0.66 min), but without clinical significance.Conclusion: Our results demonstrated similar efficacy between ciprofol and propofol for sedation and anesthetic induction, while ciprofol was associated with lower risks of hypotension and pain on injection. Future studies are warranted to evaluate the efficacy and safety of ciprofol in pediatric or the elderly populations.Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/), identifier (CRD42023421278).

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation

Hung,

Chen,

et al. 2023

Front. Pharmacol.

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Comparison Between Dexmedetomidine and Midazolam-Fentanyl Combination in Flexible Bronchoscopy

Magazine,

Elenjickal,

Padukone

et al. 2024

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Dexmedetomidine has acceptable clinical utility for inducing sedation during flexible bronchoscopy. Reducing its dose may not only ameliorate its cardiovascular side effects, but also maintain its clinical usefulness. Methods: Patients between 18 and 65 years were randomized to either dexmedetomidine (0.75 µg/kg) or the midazolam-fentanyl group (0.035 mg/kg midazolam and 25 mcg fentanyl). The primary outcome measure was the composite score. Other parameters noted were: oxygen saturation, hemodynamic variables, Modified Ramsay Sedation Score, Numerical Rating Scale (NRS) for pain intensity and distress, Visual Analog Scale score for cough, rescue medication doses, ease of doing bronchoscopy, and patient response 24 hours after bronchoscopy. Results: In each arm, 31 patients were enrolled. The composite score at the nasopharynx was in the ideal category in 26 patients in dexmedetomidine and 21 in the midazolam-fentanyl group (P=0.007). At the tracheal level, the corresponding values were 24 and 16 (P=0.056). There was no significant difference between the 2 groups regarding the secondary outcome measures except hemodynamic parameters. The mean heart rate in the dexmedetomidine and midazolam-fentanyl groups, respectively, was as follows: at 10 minutes after start of FB (90.10±14.575, 104.35±18.48; P=0.001), at the end of FB (98.39±18.70, 105.94±17.45; P=0.016), and at 10 minutes after end of FB (89.84±12.02, 93.90±13.74; P=0.022). No patient developed bradycardia. Two patients (P=0.491) in the dexmedetomidine group developed hypotension. Conclusion: Low-dose dexmedetomidine (0.75 μg/kg single dose) appears to lead to a better composite score compared with the midazolam-fentanyl combination.

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Comparison of methods of non-mechanical pressure measurement in the cuff of an endotracheal tube

Sadovyi,

Kuchyn

2024

USMYJ

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Bronchoscopy is a diagnostic and follow-up procedure. Despite the fact that this manipulation itself is minimally invasive, it can be a difficult test for both the patient and the doctor. Therefore, this manipulation definitely requires anesthesia and sedation. This study compared dexmedetomidine and propofol sedation methods during diagnostic bronchoscopy to assess their safety, effectiveness, and satisfaction. The results show a high level of safety of both methods, although some significant differences affecting the choice of sedation method were found. 32 patients participated in the study, divided into two groups depending on the used method of sedation: propofol or dexmedetomidine. Pulse oximetry, heart rate, capnography parameters were measured, the number and severity of iatrogenic lesions of the trachea, as well as the satisfaction of care and doctors were assessed. In some groups, there was a high level of safety of sedation. Dexmedetomidine sedation was associated with fewer cough episodes and greater satisfaction, but had a longer induction time with propofol. A low incidence of serious complications was observed in both groups. Dexmedetomidine can be considered a safe and effective sedation option for diagnostic bronchoscopy, offering additional benefits such as reduced cough episodes and increased patient satisfaction. The choice of the sedation method is based on the individual characteristics of the patient and the available resources of the hospital.

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Safety and Efficacy of Dexmedetomidine for Bronchoscopy: A Systematic Review and Meta-Analysis

Cited by 4 publications

References 34 publications

A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation

A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation

Comparison Between Dexmedetomidine and Midazolam-Fentanyl Combination in Flexible Bronchoscopy

Comparison of methods of non-mechanical pressure measurement in the cuff of an endotracheal tube

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