Propofol-esketamine versus propofol-fentanyl combinations for sedation in pediatric flexible fiberoptic bronchoscopy:...

This study aimed to compare the incidence of transient hypoxemia between pediatric patients receiving either propofol/esketamine (PK) or propofol/fentanyl (PF) combination for sedation during bronchoscopy.

This was a prospective study including a total of 84 pediatric patients who underwent pediatric flexible fiberoptic bronchoscopy (FFB). The participants were randomly assigned to either the propofol/fentanyl group (Group PF, n = 42) or the propofol/esketamine group (Group PK, n = 42) for sedation and analgesia. The primary outcome was the incidence of transient hypoxemia, defined as oxygen saturation (SpO2) < 90% lasting for 10 s. Secondary outcomes comprised hemodynamics during the procedure, including blood pressure and heart rate changes, coughing, recovery time, dosage of propofol, incidence of adverse events, and level of bronchoscopist satisfaction.

The incidence of hypoxemia was significantly lower in the Group PK compared to the Group PF (14.3% vs. 35.7%; p = 0.042). Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, and heart rate, were lower in the Group PF compared to the Group PK (p < 0.05); however, this difference was not clinically significant. Furthermore, coughing episodes were significantly reduced in the Group PK compared to Group PF (9.5% vs. 28.6%; p < 0.01). The Group PK had shorter recovery times and required more propofol compared to the Group PF (p < 0.05). Bronchoscopist satisfaction level was higher in the Group PK than Group PF (p < 0.05). No statistically significant difference was observed in the incidence of adverse events between the two groups (p > 0.05).

Propofol/esketamine sedation reduced the risk of hypoxemia during pediatric FFB compared to propofol/fentanyl, with additional benefits in cough suppression and hemodynamic stability. Therefore, the propofol/esketamine combination may offer a safer alternative for procedural sedation in pediatric FFB.