The Continental Medical College (CMC) is a private medical school located in Lahore, Punjab, Pakistan. It is registered with Pakistan Medical and Dental Council, affiliated with University of Health Sciences, Lahore and approved by the Ministry of National Health Services Regulation and Coordination, Government of Pakistan.
Bronchoscopy is a widely performed diagnostic and therapeutic intervention in pulmonary medicine. Sedatives are recommended with it to improve patient comfort and procedural outcomes. Propofol, the traditional sedative, carries risks of hemodynamic and respiratory adverse events, particularly in elderly or comorbid patients. Remimazolam, an ultra-short-acting benzodiazepine, is being explored as a potential alternative with a better safety profile. To systematically evaluate the efficacy and safety of remimazolam versus propofol for bronchoscopic procedures. Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Embase, Scopus, Web of Science, Cochrane, ClinicalTrials.gov and WHO ICTRP were searched upto May 23, 2025 for RCTs comparing remimazolam to propofol in bronchoscopy. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and random-effects models were used to pool outcomes in R software. Certainty of evidence was assessed using the GRADE approach. Six RCTs met the eligibility criteria and were included, involving 718 patients (359 in each group, mean ages 49.7 to 71.5 years, ASA status I-IV). No significant differences were observed in time to loss of consciousness, time to awake, or successful sedations. However, remimazolam use was associated with a significantly lower risks of hypotension (Risk Ratio [RR] 0.46, 95
Introduction Chemotherapy-related cardiotoxicity, leading to reduced Left Ventricular Ejection Fraction (LVEF), remains a significant clinical challenge for breast cancer patients. Cardioprotective medications have been proposed to mitigate these effects; however, evidence on the optimal therapeutic option is unclear. Hypothesis We hypothesized that certain cardioprotective medications provide superior efficacy in preserving LVEF among breast cancer patients undergoing chemotherapy compared to placebo. Method A systematic search of PubMed, Cochrane, Embase, Scopus, and WOS databases identified randomized controlled trials (RCTs) evaluating the efficacy and safety of cardioprotective drugs—including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and statins—in breast cancer patients undergoing chemotherapy. Frequentist network meta-analysis was performed using the ‘netmeta’ package in Rstudio (version 4.4.2). We applied a random-effects model to calculate mean differences (MD) with 95% confidence intervals (CI). Treatments were ranked by the surface under the cumulative ranking curve (SUCRA); higher SUCRA scores reflect greater effectiveness. Result Eighteen RCTs comprising 2223 breast cancer patients on chemotherapy were included. Spironolactone demonstrated the highest efficacy in preserving LVEF (MD: -12.80%, 95% CI: [-17.62; -7.98], SUCRA: 0.9935, P<0.0001), followed by Nebivolol (MD: -7.30%, 95% CI: [-12.34; -2.26], SUCRA: 0.8721, P=0.0045) and the Lisinopril+Bisoprolol combination (MD: -5.25%, 95% CI: [-10.13; -0.37], SUCRA: 0.7512, P=0.0350). Bisoprolol (MD: -3.03%, SUCRA: 0.5561, P=0.0190) and Candesartan (MD: -2.93%, SUCRA: 0.5524, P=0.0013) showed moderate yet significant benefits. Metoprolol (MD: 0.83%, P=0.5818), Carvedilol (MD: 0.99%, P=0.0658), and Perindopril (MD: -1.51%, P=0.3533) did not significantly outperform placebo. Conclusion Spironolactone, Nebivolol, and Lisinopril+Bisoprolol showed significant protective effects on LVEF in breast cancer patients receiving chemotherapy. Spironolactone was identified as the most effective option, whereas Carvedilol, Metoprolol, and Perindopril had limited benefit. These findings support using Spironolactone, Nebivolol, or combination therapies for cardioprotection during chemotherapy.
