Efficacy And Safety Of Subanesthetic Dose Of Esketamine In Bronchoscopy Of Elderly Patients

ObjectiveThe subjects of bronchoscopy are usually the elderly.With the increase of age,the physiological function of elderly patients gradually decreased,and the cardiovascular reserve decreased.In addition,bronchoscopy is highly irritating to the throat and tracheal mucosa,and adverse reactions such as hypotension,cough,bronchospasm and so on often occur in different degrees during the perioperative period.At present,there is still a need to find a more suitable anesthesia scheme for bronchoscopy in elderly patients.The purpose of this study is to investigate the effect of asketamine combined with propofol-remifentanil in bronchoscopy in elderly patients,so as to provide a more optimized anesthesia plan for elderly patients and provide a reference for clinical practice.MethodsA total of 114 elderly patients,aged 65-80 years,BMI 18-25 kg/m2,ASA physical status Ⅱ or Ⅲ,who were scheduled for fibrobronchoscopy were selected in our hospital.The patients were divided into two groups by computer,57 patients in each group:respectively esketamine group(group E)and control group(group C).During anesthesia induction,group E was given 0.2 mg/kg esketamine intravenously,and group C was given equal volume 0.9%normal saline.Under marsh mode,the concentration of propofol effect chamber in target controlled infusion(TCI)was 3 μg/ml,and the concentration of remifentanil effect chamber was 4 ng/ml in Minto model.After plasma concentration was balanced with effect chamber concentration and jaw relaxation,laryngeal mask was placed and bronchoscopy was started.After the bronchoscope entered,the effect chamber concentrations of propofol were adjusted to 1.5-3 μg/ml and remifentanil were adjusted to 2-4 ng/ml respectively.HR,MAP,SpO2 and NI values were also noted at following time points:After the patient entered the room and was quiet for 10 minutes(T0),when the eyelash reflex disappeared(T1),when the bronchoscope was placed(T2),when it reached the glottis(T3),carina(T4),main trachea(Ts),bronchus(T6),after operation(T7),when the laryngeal mask was removed(Ts),and when leaving the room(T9).The dosage of propofol and remifentanil were recorded.The incidence of hypotension,the amount of ephedrine used during the operation and the postoperative recovery quality score(QoR-40)were recorded.The occurrence of adverse reactions including cough,bronchospasm,hypoxemia,dizziness,nausea and vomiting,postoperative pharyngalgia and pseudo-psychotic symptoms were recorded.ResultsCompared with T0,HR and MAP in group E increased significantly at T1(P<0.05).In group C,MAP and HR decreased significantly at T1 and T2(P<0.05),and MAP increased significantly at T3 and T4(P<0.05).Compared with group C,the use of propofol and remifentanil in group E was significantly reduced,the incidence of hypotension and the use of ephedrine were reduced,and the incidence of cough,bronchospasm and postoperative pharyngalgia were significantly reduced(P<0.05).There was no significant difference in the incidence of postoperative dizziness,nausea and vomiting and the score of postoperative recovery quality between the two groups(P>0.05).ConclusionThe results of this study showed that Subclinical dose of Esketamine(0.2 mg/kg)combined with TCI propofol-remifentanil can be safely and effectively used for bronchoscopy in elderly patients,which can not only reduce the dosage of propofol and remifentanil by 11.6%and 4.5%respectively,but also have stable hemodynamics and few adverse reactions.The use of low-dose Esketamine does not affect the quality of postoperative recovery.