Prospective Randomized Trial Evaluating Ketamine for Adult Bronchoscopy

Area of Science:

• Pulmonology
• Anesthesiology
• Critical Care Medicine

Background:

• Ketamine is established for pediatric sedation during flexible fiberoptic bronchoscopy (FFB).
• Its use in adult FFB sedation is limited due to insufficient safety and efficacy data.
• This study addresses the gap in understanding ketamine's role in adult FFB.

Purpose of the Study:

• To compare the safety and efficacy of ketamine-propofol-midazolam (KPM) versus fentanyl-propofol-midazolam (FPM) for adult sedation during FFB.
• To evaluate respiratory and hemodynamic stability, and patient and operator satisfaction.

Main Methods:

• A prospective randomized trial involving 80 adult patients undergoing FFB.
• Patients were randomized to receive either KPM or FPM sedation.
• Continuous monitoring of vital signs, including transcutaneous carbon dioxide tension (TcPCO2), was performed.

Main Results:

• No significant differences were observed in maximal intraprocedural TcPCO2 or minimal oxygen saturation between the KPM and FPM groups.
• Sedation-related respiratory or hemodynamic complications were similar in both groups.
• Operator and patient satisfaction levels were comparable between the KPM and FPM regimens.

Conclusions:

• Ketamine demonstrates comparable safety and efficacy to fentanyl for adult analgesia and sedation in FFB.
• Ketamine's lack of hemodynamic suppression and potent bronchodilator properties support its broader adoption for adult FFB sedation.