Safety and efficacy of dexmedetomidine in interventional chest procedures: A systematic review

Interventional chest procedures, including medical thoracoscopy (MT) and video-assisted thoracoscopic surgery (VATS), are integral to diagnosing and treating thoracic conditions. Dexmedetomidine is increasingly used for sedation in these procedures due to its favorable pharmacological profile, yet its comparative efficacy and safety remain inadequately defined. This systematic review aims to comprehensively summarize the available evidence on the efficacy and safety of dexmedetomidine for sedation during MT and VATS.

Following PRISMA guidelines, we searched 4 electronic databases (PubMed, Web of Science, Cochrane Library, Scopus) for studies published until August 2024. We included randomized controlled trials (RCTs) and observational studies that assessed dexmedetomidine in patients undergoing MT or VATS. Outcomes measured included pain scores, postoperative complications, and lengths of hospital or care unit stay.

Seven studies (six RCTs and one prospective cohort study) involving a total of 442 patients were included. Dexmedetomidine demonstrated enhanced analgesic efficacy in comparison to midazolam across multiple investigations. Although dexmedetomidine has shown promise in reducing intensive care unit durations in certain studies, its influence on overall hospital length of stay exhibited variability. Adverse events were largely comparable between the 2 sedatives, although instances of hypotension were noted more frequently with dexmedetomidine in some comparisons.

Ultimately, dexmedetomidine has emerged as a reliable sedative option for thoracoscopic interventions, providing efficient pain relief while maintaining stable respiratory parameters. Nonetheless, its cardiovascular ramifications warrant vigilant oversight. This review highlights the imperative for additional standardized research to validate these outcomes and inform evidence-based sedation protocols.