Comparison of Esketamine and Remifentanil Combined With Propofol for Painless Fiberoptic Bronchoscopy: A Randomized Controlled Trial.
Xiuli Fan, Lijuan Li, Jinshan Shi et al.
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In 30 seconds
This randomized controlled trial compared esketamine with remifentanil, each combined with propofol, for elective painless flexible fiberoptic bronchoscopy in 206 adults. Bronchospasm occurred more often with esketamine than remifentanil (47.12% vs. 29.41%, P = 0.003). The esketamine group also had more grade 2 airway secretions, higher propofol use, and longer recovery, while showing fewer episodes of hypotension and bradycardia. The findings indicate a trade-off: esketamine was associated with better hemodynamic stability but more airway adverse events and prolonged recovery.
Key findings
- Bronchospasm incidence was higher with esketamine than remifentanil (47.12% vs. 29.41%, P = 0.003).
- Grade 2 airway secretions were more frequent with esketamine (76.92% vs. 33.33%).
- Mean propofol dosage was higher with esketamine (300.01 ± 151.81 mg vs. 142.62 ± 66.72 mg), and recovery time was prolonged.
- The esketamine group had fewer episodes of hypotension and bradycardia, but higher incidences of hypertension.
Why it matters
Sedation choices for bronchoscopy may involve competing airway and hemodynamic effects. In this trial, esketamine was associated with fewer hypotensive and bradycardic events but more bronchospasm, secretions, and longer recovery than remifentanil. These results help frame the outcomes that may need consideration when comparing these regimens, without establishing that one is preferable for all patients.
What to keep in mind
The abstract reports outcomes in adults undergoing elective procedures; it does not establish whether the findings apply to other patient groups or bronchoscopy settings.