摘要
Abstract
Objective To evaluate the efficacy and safety of subanesthetic dose esketamine on remimazolam-induced sedation in elderly patients undergoing bronchoscopy.Methods Sixty elderly patients,including 46 males and 14 females,aged 60-77 years old,with body mass index(BMI)18-28 kg/m2,of American Society of Anesthesiologists(ASA)Physical Status classification Ⅰ or Ⅱ,sched-uled for elective bronchoscopy at Shanxian Central Hospital from July 2024 to February 2025 were selected.According to random number table method,patients were divided into the control group(group C,n=30)and the esketamine group(group E,n=30).Before anes-thesia induction,group E received intravenous(IV)esketamine 0.2 mg/kg,while group C received an equivalent volume of normal sa-line.One minute later,both groups underwent anesthesia induction with IV remimazolam 0.2 mg/kg combined with sufentanil 0.1 μg/kg.After jaw relaxation,a laryngeal mask was inserted for fiberoptic bronchoscopy.Intraoperatively,sedation was maintained with remimazo-lam infusion at 1.0-1.5 mg/(kg·h),and additional sufentanil 0.05 μg/kg was administered intermittently if coughing or body move-ment occurred.Mean arterial pressure(MAP)and heart rate(HR)were recorded at the entry of the operation room(T0),after anesthe-sia induction(T1),after laryngeal mask insertion(T2),during bronchoscope entry into the glottis(T3),and during bronchoscope pas-sage through the carina(T4).Secondary outcomes including assisted ventilation time,recovery time,laryngeal mask removal time,total doses of remimazolam and sufentanil,and adverse events(hypertension,hypotension,hypoxemia,body movement/coughing,postopera-tive sore throat,delayed recovery,dizziness/fatigue,and nausea/vomiting)were recorded.Results At T1,MAP and HR in group E were significantly higher than those in group C,while at T3 and T4,MAP and HR were significantly lower than those in group C,with sta-tistically significant difference(P＜0.05).Group E had shorter assisted ventilation time(3.73±7.95 vs 35.10±20.75)and laryngeal mask removal time(2.03±0.81 vs 4.00±1.91),as well as lower total doses of remimazolam(29.57±4.34 vs 32.63±5.02)and sufentanil(15.67±2.54 vs 19.43±3.91)(P＜0.05).The incidences of intraoperative hypotension(0.00％vs 23.33％),hypoxemia(0.00％vs 20.00％),and body movement/coughing(0.00％vs 16.67％)were significantly lower in group E,with statistically signifi-cant difference(P＜0.05).Conclusion In elderly patients undergoing bronchoscopy,administration of subanesthetic dose esketamine can effectively reduce the required doses of remimazolam and sufentanil,improve hemodynamic and respiratory stability,without prolon-ging recovery time and with fewer complications.This approach is worthy of clinical application.关键词
艾司氯胺酮/瑞马唑仑/老年患者/支气管镜检查Key words
esketamine/remimazolam/elderly patients/bronchoscopy
