Midazolam 20mg/0.5ml / Lidocaine 10mg/0.5ml nasal solution ampoules

BackgroundCombining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks.MethodsA systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.ResultsOf 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] -1.81 min, 95% confidence interval [CI] -3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI -2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD -172.88 min, 95% CI -215.18 to -130.59; PConclusionsNo clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.

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BackgroundTherapeutic gastrointestinal endoscopy, including endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection, requires effective sedation strategies to ensure procedural success and patient safety. However, optimal pharmacological regimens remain unclear, particularly for prolonged procedures.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomised controlled trials comparing pharmacological sedation strategies in patients undergoing therapeutic gastrointestinal endoscopy. Outcomes included procedural interference events, hypoxia, hypotension, bradycardia, recovery time, induction time, satisfaction, and postoperative nausea and vomiting. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was rated using GRADE framework. A frequentist random-effects network meta-analysis was conducted, along with cluster ranking of co-primary outcomes to evaluate benefit-risk trade-offs.ResultsSixty randomised controlled trials involving 7,071 patients and 32 pharmacological regimens were included. Compared with propofol-opioid, which remained the reference standard, no regimen significantly reduced procedural interference events. Ketamine-propofol demonstrated consistent advantages across hypoxia (relative risk [RR] 0.12, 95% confidence interval [CI] 0.03 to 0.59, P = 0.009; moderate certainty), hypotension (RR 0.28, 95% CI 0.09 to 0.83, P = 0.021; low certainty), and bradycardia (RR 0.11, 95% CI 0.01 to 0.86, P = 0.035; moderate certainty). Cluster rank analyses identified ketamine-propofol and lidocaine-midazolam-propofol as the highest-ranking regimens in both efficacy and safety domains. Meta-regression revealed no significant effect modifiers.ConclusionWhile propofol-opioid remains the standard reference, alternative sedation strategies such as ketamine-propofol and lidocaine-midazolam-propofol offer favourable profiles for therapeutic gastrointestinal endoscopy. These findings support individualised regimen selection based on patient and procedural needs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251018215.

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PurposeThe 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.Materials and methodsWe 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.ResultsTwenty-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%).ConclusionThese NMA findings suggest that, in terms of reducing the risk of hypoxemia, intravenous remimazolam is the safest sedative agent for patients undergoing bronchoscopy.

Abstract licence: CC BY-NC