Comparative Safety of Intravenous Sedatives for Bronchoscopy: A Bayesian Network Meta-Analysis

The selection of sedatives for bronchoscopy procedures remains debated. This study evaluates the safety of intravenous midazolam, propofol, dexmedetomidine, and remimazolam as sedative agents during flexible bronchoscopy.

We conducted a Bayesian network meta-analysis (NMA) using PubMed, Embase, and the Cochrane Central Register. Between-group comparisons were estimated using odds ratios (ORs) with 95% credible intervals (95% CIs). Surface under the cumulative rank curve (SUCRA) plots were produced. The rate of hypoxemia was the primary outcome.

Twenty-four randomized controlled trials involving 4010 patients were included. Baseline variables were generally well balanced across sedative agents in the transitivity analysis, and the node-splitting approach demonstrated a high degree of concordance among the comparisons. The NMA results indicate that remimazolam was significantly associated with a lower rate of hypoxemia than midazolam (OR 0.36, 95% CI 0.18 to 0.79) and propofol (OR 0.33, 95% CI 0.16 to 0.69). Based on their SUCRA values, the ranking of the four sedative agents from most to least favorable was intravenous remimazolam, followed by dexmedetomidine, midazolam, and propofol. The probability of intravenous remimazolam being the most effective treatment was 93.4%. The SUCRA values also showed that midazolam had the lowest risk of hypotension (79.6%), and propofol had the lowest risk of bradycardia (90.4%).

These NMA findings suggest that, in terms of reducing the risk of hypoxemia, intravenous remimazolam is the safest sedative agent for patients undergoing bronchoscopy.