Comparison of Esketamine and Remifentanil Combined With Propofol for Painless Fiberoptic Bronchoscopy: A Randomized...

This randomized controlled trial was designed to compare the efficacy and safety of esketamine versus remifentanil respectively combined with propofol for painless fiberoptic bronchoscopy (FFB).

A total of 206 patients undergoing elective painless FFB were randomly divided into 2 groups. The experimental group (n = 104) received anesthesia induction with esketamine 0.5 mg/kg, propofol 2 to 3 mg/kg, and rocuronium 0.3 mg/kg, followed by maintenance with esketamine 0.5 to 3 mg·kg^-1·h^-1 and propofol 4 to 9 mg·kg^-1·h^-1. The control group (n = 102) received induction with remifentanil 1 µg/kg, propofol 2 to 3 mg/kg, and rocuronium 0.3 mg/kg, with maintenance using remifentanil 3 to 9 µg·kg^-1·h^-1 and propofol 4 to 9 mg·kg^-1·h^-1. Primary outcomes included bronchospasm incidence and airway-related indicators. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), peripheral oxygen saturation (SpO₂) were recorded at 5 time points: pre-induction (T1), post-induction (T2), bronchoscope insertion (T3), 10 minutes after insertion (T4), and end of procedure (T5). Airway pressure was recorded at T3, T4, and T5.

Compared with the control group, the experimental group had a significantly higher incidence of bronchospasm (47.12% vs. 29.41%, P = 0.003), and a significantly higher proportion of patients with grade 2 airway secretions (76.92% vs. 33.33%), higher propofol dosage (300.01 ± 151.81 mg vs. 142.62 ± 66.72 mg), elevated SBP/DBP/HR at T3-T5, increased airway pressure at T4-T5, higher incidences of hypertension, lower incidences of hypotension and bradycardia, reduced grade 0 cough scores, increased grade 5 cough scores, decreased grade 0 to 1 sputum volume, increased grade 4 sputum volume, and prolonged recovery time (all P < 0.05). No significant differences were observed in airway stenosis grade, bronchial mucosal swelling/congestion, other adverse events, NRS pain score, operator/anesthesiologist satisfaction, operation duration, or discharge time (all P > 0.05).

In this study of adult patients undergoing elective painless flexible fiberoptic bronchoscopy, esketamine was associated with better hemodynamic stability but increased risks of airway adverse events and prolonged recovery time, requiring vigilant perioperative management in appropriately selected patients.