Comparison of older and newer sedation agents in bronchoscopy

Flexible bronchoscopy is an important diagnostic and therapeutic modality in pulmonary medicine. Appropriate sedation is essential for patient safety and comfort. Several agents, such as benzodiazepine and opiates (fentanyl, Midazolam, and morphine), have been used for conscious sedation and anxiolytics. Lately, there has been an influx of newer sedation agents that have been valuable in bronchoscopy because of their beneficial properties. For example, Ketamine, a dissociative anesthetic, has been used during bronchoscopic procedures as an alternative to conventional sedatives or as an adjunct to them. Its bronchodilatory effects, minimal respiratory depression, sympathomimetic effect leading to hemodynamic stability, and analgesic properties make it particularly valuable in high-risk populations, including patients with respiratory compromise. Besides Ketamine, Esketamine, Dexmedetomidine, and other agents are also being used. This minireview explores the role of older and newer agents in bronchoscopy, highlighting their efficacy, safety profile, and potential advantages.