A synthesis cannot supply equally strong evidence for every drug pair when few studies test each pair.
The review included six studies and 1,331 older patients. Most compared dexmedetomidine with propofol, with differing findings. Only a smaller portion addressed other comparisons, including midazolam, and those did not clearly show a delirium difference.
Heterogeneous populations, regimens and outcome assessments restrict a universal ranking. Evidence from one comparison should not silently be treated as direct evidence for another. Study counts and sample distribution matter alongside the overall conclusion.
Check which trials actually support the cited drug pair. The review cannot establish that changing one sedative would prevent an individual delirium episode. Baseline cognition, illness and subsequent care remain important, and a summary preference should retain the uncertainty of the underlying comparisons.
Source: PMC12503417, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
Related: Etomidate–Midazolam Versus Propofol–Ketamine in Patients With Reduced Ejection Fraction.