Effect Of Esketamine On Quality Of Early Postoperative Recovery In Patients Undergoing Painless Fiberoptic Bronchoscopy

Objective:Through the application of esmketamine combined with propofol in painless fiberoptic bronchoscopy,the changes of respiration and circulation during operation,postoperative recovery and related adverse events were observed,and the effects of esmketamine combined with propofol on the hemodynamic stability during operation and the quality of early recovery after operation were discussed.Methods:60 patients who underwent painless fiberoptic bronchoscopy in Hefei Hospital affiliated to Anhui Medical University from June 2020 to June 2021 were randomly divided into 2 groups:esketamine group（Group S）and fentanyl group（Group F）,with 30 patients in each group.Patients in group S were slowly injected with0.3mg/kg of esketamine and 2.5mg/kg of propofol during anesthesia induction;Patients in group F were given fentanyl 1ug/kg combined with propofol 2.5mg/kg during anesthesia induction;During the operation,propofol was continuously pumped for 5～7Mg/kg/h to maintain anesthesia,and the dose was adjusted in time according to the patient’s body movement to maintain the BIS value at about 50～60.The changes of mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（Sp O₂）and bis-frequency index（BIS）were observed and recorded before anesthesia induction（T₁）,after laryngeal mask placement（T₂）,immediately after fiberoptic bronchoscopy entry（T₃）and immediately after fiberoptic bronchoscopy examination（T₄）.Quality of recovery Scale score（Qo R-40）was performed 1d preoperatively（T₀）and 1d postoperatively（T₅）.The dosage of propofol and the incidence of adverse events such as propofol injection pain,choking cough,apnea,nausea and vomiting,hallucinations and nightmares were recorded;The satisfaction of bronchoscopy doctors and patients in the two groups were recorded.Results:1.Comparison of general data:there was no significant difference in gender,age,weight,ASA grade,operation time,anesthesia time and recovery time between the two groups（P>0.05）;2.Comparison of MAP,HR,Sp O₂ and BIS between the two groups:there was no significant difference in MAP,HR and Sp O₂ between the two groups at T₁ time（P>0.05）.At T₂time,MAP,HR and Sp O₂ in group S were higher than those in group F（P<0.05）;Compared with T₁ time,MAP and HR in group F decreased significantly at T₂time（P<0.05）,while there was no significant change in group S.Sp O₂ levels in both groups decreased,especially in group F;Compared with T₂ time,MAP and HR levels in the 2 groups were significantly increased at T₃ time（P<0.05）;There was no significant difference in BIS between the 2 groups at each time point（P>0.05）;3.Comparison of Qo R-40 scores between the two groups:At T₀ time,there was no significant difference in each score and total score of Qo R-40 scale between the two groups（P>0.05）;At T₅time,the physical comfort,emotional state,psychological support,pain score and total score of group S were significantly higher than those of group F（P<0.05）;4.Comparison of propofol dosage between the two groups:There was no significant difference in the induced dose of propofol between the two groups（P>0.05）;Compared with group F,the total dose of propofol in group S decreased significantly（P<0.05）;5.Comparison of adverse event rates between the two groups:The incidence of injection pain and apnea in group S was significantly lower than that in group F（P<0.05）;There was no significant difference in the incidence of choking,nausea and vomiting between the two groups（P>0.05）,but the number of cases in group S was less;All patients were free hallucinations and nightmares.（P>0.05）;6.Comparison of satisfaction of bronchoscopy doctors and patients between the two groups:There was no significant difference in the satisfaction of bronchoscopy doctors and patients between the two groups（P>0.05）.Patients in group S were willing to accept the same examination again,and 28 patients in group F were willing to accept the same examination again.Patients in both groups did not remember the examination process.Conclusion:Compared with fentanyl,patients with esketamine during painless fiberoptic bronchoscopy had more stable intraoperative vital signs,significantly improved quality of early postoperative recovery,and a lower incidence of adverse events.