EVALUATION OF DEXMEDETOMIDINE AS A SEDATIVE AGENT FOR COLONOSCOPY: A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS

Objectives To compare the efficacy and safety of dexmedetomidine (DEX) with other sedatives (propofol, fentanyl, midazolam) in patients undergoing colonoscopy, hemodynamic stability, and adverse effects.

Methods Following PRISMA guidelines, we searched PubMed, Scopus, Cochrane, and Web of Science databases for studies comparing the use of DEX with other commonly used sedative agents in colonoscopy procedures (propofol, fentanyl and midazolam). The primary outcome analyzed was the incidence of adverse effects, specifically bradycardia, hypotension, and nausea and vomiting in both groups. Additionally, Heart Rate (HR) and Mean Arterial Pressure (MAP) were analyzed in the DEX group compared to the propofol and fentanyl groups 10 minutes after the onset of sedation. Risk ratios (RR) and standardized mean differences (SMD) with a 95% confidence interval (CI) were calculated using a random-effects model. The I² statistic and a leave-one-out analysis were used to assess heterogeneity.

Results Six studies, totaling 444 patients, with 209 receiving DEX, were included. The analysis revealed that the incidence of hypotension was similar between the two groups (RR=1.88; 95%CI: 0.65 - 5.67, p=0.25; I²=55%), such as the occurrence of nausea and vomiting (RR=1.57; 95%CI: 0.27 - 9.06, p=0.61; I²=61%). However, the use of DEX as a sedative agent was associated with a significantly higher incidence of bradycardia (RR=2.76; 95% CI: 1.41 - 5.40, p< 0.01; I²=0%). Regarding MAP 10 minutes after the onset of the procedure, no differences were observed when compared to fentanyl (SMD= -0.04; 95% CI: -0.35 - 0.27, p=0.78; I²=0%) or propofol (SMD= -0.30; 95% CI: -0.71 - 0.11, p=0.15; I²=33%). Finally, the analysis of HR revealed a significant difference between the DEX group and the propofol group (SMD= -1.31; 95% CI: -1.90 - 0.71, p< 0.01; I²=60%), but no difference was observed when compared to the fentanyl one (SMD= 0.12; 95% CI: -0.32 - 0.56, p=0.58; I²=48%).

Conclusion DEX demonstrates efficacy and safety comparable to other sedatives in colonoscopy, with similar incidences of hypotension and nausea/vomiting, but a higher risk of bradycardia. While no significant differences were observed in MAP compared to fentanyl or propofol, there was a significant difference in HR compared to propofol, but not with fentanyl. These findings suggest that dexmedetomidine may offer effective sedation for colonoscopy, but clinicians should be vigilant for potential bradycardia.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025