Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi, Guizhou, 563000, P.R. China.
Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, Guizhou, 563003, P.R. China.
BMC Pulm Med. 2023 Jul 11;23(1):254. doi: 10.1186/s12890-023-02517-1.
Ideal sedation and analgesia strategies for fiberoptic bronchoscopy have not been found. At present, propofol based sedation strategy still has some defects, such as respiratory depression and blood pressure drop. It is difficult to meet the requirements of safety and effectiveness at the same time. The aim of this study was to compare the clinical efficacy of propofol/remifentanil with propofol/esketamine for patient sedation during fiberoptic bronchoscopy.
Patients undergoing fiberoptic bronchoscopy were randomly assigned to propofol/ remifentanil (PR group; n = 42) or propofol/esketamine (PK group; n = 42) for sedation and analgesia. The primary outcome was the rate of transient hypoxia (oxygen saturation (SpO) < 95%). The secondary outcomes are the intraoperative hemodynamics, including the changes in blood pressure, heart rate, the incidence of adverse reactions, the total amount of propofol usage were recorded, and the satisfaction level of patients and bronchoscopists.
After sedation, the arterial pressure and heart rate of patients in the PK group were stable without significant decrease. Decreases in diastolic blood pressure, mean arterial pressure, and heart rate were observed in patients in the PR group (P < 0.05), although it was not of clinical relevance. The dosage of propofol in the PR group was significantly higher than that in the PK group (144 ± 38 mg vs. 125 ± 35 mg, P = 0.012). Patients in the PR group showed more transient hypoxia (SpO < 95%) during surgery (7 vs. 0, 0% versus 16.6%, P = 0.018), more intraoperative choking (28 vs. 7, P < 0.01), postoperative vomiting (22 vs. 13, P = 0.076) and vertigo (15 vs. 13, P = 0.003). Bronchoscopists in the PK group showed more satisfaction.
Compared with remifentanil, the combination of esketamine with propofol in fiberoptic bronchoscopy leaded to more stable intraoperative hemodynamics, lower dosage of propofol, lower transient hypoxia rate, fewer incidence of adverse events, and greater bronchoscopists satisfaction.
目前尚未找到理想的纤维支气管镜检查镇静和镇痛策略。基于丙泊酚的镇静策略仍然存在一些缺陷，如呼吸抑制和血压下降，同时满足安全性和有效性的要求具有一定难度。本研究旨在比较丙泊酚/瑞芬太尼与丙泊酚/依托咪酯用于纤维支气管镜检查患者镇静的临床疗效。
接受纤维支气管镜检查的患者被随机分配至丙泊酚/瑞芬太尼（PR 组；n=42）或丙泊酚/依托咪酯（PK 组；n=42）进行镇静和镇痛。主要结局是短暂性低氧血症（氧饱和度（SpO）<95%）的发生率。次要结局是术中血流动力学，包括血压、心率的变化，不良反应的发生率，丙泊酚总用量，并记录患者和支气管镜医师的满意度。
镇静后，PK 组患者的动脉压和心率稳定，无明显下降。PR 组患者舒张压、平均动脉压和心率下降（P<0.05），但无临床意义。PR 组丙泊酚用量明显高于 PK 组（144±38mg 比 125±35mg，P=0.012）。PR 组患者术中更易出现短暂性低氧血症（SpO<95%）（7 例比 0 例，0%比 16.6%，P=0.018），术中呛咳更多（28 例比 7 例，P<0.01），术后呕吐更多（22 例比 13 例，P=0.076），眩晕更多（15 例比 13 例，P=0.003）。PK 组支气管镜医师的满意度更高。
与瑞芬太尼相比，依托咪酯与丙泊酚联合应用于纤维支气管镜检查可使术中血流动力学更稳定，丙泊酚用量更低，短暂性低氧血症发生率更低，不良反应发生率更低，支气管镜医师满意度更高。
