Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy: a randomized trial

Abstract

Background Ideal sedation and analgesia strategies for fiberoptic bronchoscopy have not been found. At present, propofol based sedation strategy still has some defects, such as respiratory depression and blood pressure drop, which is difficult to meet the requirements of safety and effectiveness at the same time. The aim of this study was to compare the clinical efficacy of propofol/remifentanil with propofol/esketamine for patient sedation during fiberoptic bronchoscopy. Method: Patients undergoing fiberoptic bronchoscopy were randomly assigned to receive either propofol/ remifentanil (PR group; n = 42) or propofol/esketamine (PK group; n = 42) for sedation and analgesia. Changes in blood pressure, heart rate, and oxygen saturation were monitored. The incidence of adverse reactions, the total amount of propofol usage were recorded. satisfaction level of patients and bronchoscopists was evaluated. Results After sedation, the arterial pressure and heart rate of patients in the PK group were stable without significant decrease. Decreases in diastolic blood pressure, mean arterial pressure, and heart rate were observed in patients in the PR group (P < 0.05). The dosage of propofol in the PR group was significantly higher than that in the PK group (144.43 ± 38.19 mg vs. 124.98 ± 35.30 mg, P = 0.012). Patients in the PR group showed more intraoperative cough (28 vs. 7, P < 0.01), postoperative vomiting (22 vs. 13, P = 0.076) and vertigo (15 vs. 13, P = 0.003). Bronchoscopists in the PK group showed more satisfaction. Conclusion Compared with remifentanil, the combination of esketamine with propofol in fiberoptic bronchoscopy provided more stable intraoperative hemodynamics, lower dosage of propofol, fewer incidence of adverse events, and greater bronchoscopists satisfaction.

Comparison of esketamine and remifentanil in combination with propofol in patients with septic shock receiving invasive mechanical ventilation: a randomized controlled trial

“…Esketamine, the newly marketed S-enantiomer of ketamine, has enhanced anesthetic effect [25] and reduced incidences of psychiatric side effects of ketamine [26]. The cardiovascular excitation effect of esketamine can provide stable mean arterial pressure and heart rate without signi cant uctuation [27][28][29]. Esketamine increases cardiac output in a dose-dependent manner and improves blood pressure stability and decrease the incidence of hypotension [30].As a result, esketamine provides better circulative stability and stable hemodynamics [31].…”

The impact of remimazolam on hypoxemia in elderly patients undergoing bronchoscopy: a prospective cohort study

“…A number of previous studies have shown that propofol has emerged as a valuable agent for beroptic bronchoscopy due to its rapid induction of sedation or anesthesia, quick recovery, high clearance rate, and good tolerance [15,16]. Combining propofol with local anesthetics or opiates can further improve patient compliance by addressing coughing and a sense of asphyxiation are reduced.…”

The Impact of Remimazolam on Hypoxemia in Elderly Patients Undergoing Flexible Bronchoscopy: A Prospective Cohort Study

“…A number of previous studies have indicated that propofol has considered as a bene cial agent for FB due to its fast sedation or anesthesia onset, rapid recovery, high clearance rate, and high tolerance [15,16]. Combining propofol with local anesthetics or opiates can further improve patient compliance by alleviating coughing and reducing feelings of asphyxiation.…”