Efficacy and safety of dexmedetomidine in adult patients undergoing bronchoscopy: A systematic review and meta-analysis

Abstract

Objectives: Dexmedetomidine has been increasingly used as an alternative sedative agent during bronchoscopy, but its comparative efficacy and safety remain unclear. This systematic review and meta-analysis aimed to assess the effectiveness and safety of dexmedetomidine compared with other sedative agents in adult bronchoscopy.

Methodology: PubMed, Embase, CENTRAL, and Scopus were searched up to 17 December 2025 for randomised controlled trials (RCTs) comparing dexmedetomidine with other sedatives. Procedural success was assessed descriptively, while procedural duration, satisfaction scores, safety and hemodynamic parameters were analyzed quantitatively in a random-effects model.

Results: Seventeen RCTs were included. Qualitative synthesis showed mixed results for the adequacy of sedation between dexmedetomidine and midazolam or propofol. However, studies did note a tendency for better sedation with remimazolam as compared to dexmedetomidine. Compared with midazolam, dexmedetomidine significantly reduced the incidence of hypoxia, but was associated with higher risks of bradycardia and reduced risk of hypotension; no consistent differences were observed in procedure duration or rescue sedation. Compared with propofol, dexmedetomidine was associated with lower rates of hypoxia and hypertension but a higher incidence of bradycardia. Compared with remimazolam, dexmedetomidine was associated with lower patient satisfaction scores and higher rates of hypoxia, whereas other safety outcomes did not show any significant difference. Studies comparing dexmedetomidine with opioids were scarce.

Conclusions: Evidence shows dexmedetomidine is an effective sedative for adult bronchoscopy, comparable to midazolam and propofol in sedation levels. It may reduce hypoxia but increases bradycardia. Compared with remimazolam, it seems to offer less favourable sedation with a higher risk of hypoxia. However, data was from a limited number of studies.