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已发表论文
艾司氯胺酮联合瑞马唑仑减少芬太尼用量对老年患者支气管镜检查的影响
Authors Xie A, Zhang X , Han J, Wu D, Ju F, Zhou Y , Zhou R
Received 28 July 2025
Accepted for publication 18 November 2025
Published 25 November 2025 Volume 2025:19 Pages 10485—10493
DOI https://doi.org/10.2147/DDDT.S556743
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Anastasios Lymperopoulos
An Xie,1 Xianjie Zhang,1 Jia Han,1 Dan Wu,2 Feng Ju,1 Yukai Zhou,1 Rui Zhou3
1Department of Anesthesiology, Deyang People’s Hospital, Deyang, People’s Republic of China; 2Operating Room, Deyang People’s Hospital, Deyang, People’s Republic of China; 3Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
Correspondence: Rui Zhou, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, No. 1279, Sanmen Road, Hongkou District, Shanghai, 200434, People’s Republic of China, Email ruizhoukepler@126.com
Objective: This randomized controlled study aimed to explore the safety and efficacy of a fentanyl-reduced regimen combining esketamine and remimazolam for bronchoscopy in elderly patients.
Methods: A total of 274 elderly patients (aged 65– 85 years, ASA I–III) underwent bronchoscopy in our hospital from September 2024 to May 2025 were randomly divided into two groups: the study group (remimazolam 0.2 mg/kg + esketamine 0.3 mg/kg + fentanyl 0.5 ug/kg) and the control group (remimazolam 0.2 mg/kg + fentanyl 1.5 ug/kg). Remimazolam 0.05 mg/kg was added as needed to maintain sufficient sedation in both groups. The primary outcome was the incidence of procedure-related hypoxemia (SpO2 < 90%). Secondary outcomes included the procedural success rate, recovery metrics (time to awakening, time to discharge, and quality of recovery score), satisfaction levels (patient and endoscopist scores), and adverse events (incidences of hypotension and hypertension, degree of salivation, and body movements like coughing or limb swings).
Results: The study group had a lower incidence of hypoxemia (2.19% vs 9.49%, p = 0.010) and shorter awakening time (17.47 ± 3.10 vs.19.33 ± 3.78, p < 0.001), as well as a higher QoR-15 score (138.95 ± 2.41 vs 137.38 ± 2.70, p < 0.001) compared to the control group. The incidence of hypotension was significantly lower in the study group (0.73% vs 18.25%, p < 0.001). Although the study group exhibited a significantly higher degree of salivation (p < 0.001), no aspiration occurred. There were no significant differences in sedation success rate, discharge time, patient/endoscopist satisfaction, or incidence of agitation between the two groups.
Conclusion: The fentanyl-reduced regimen ensures sedation efficacy, and reduces adverse events like respiratory depression and hypotension, despite increasing salivation. It provides a safer anesthetic option for bronchoscopy in elderly patients.
Keywords: esketamine, remimazolam, fentanyl, hypoxemia, bronchoscopy, elderly patients
1Department of Anesthesiology, Deyang People’s Hospital, Deyang, People’s Republic of China; 2Operating Room, Deyang People’s Hospital, Deyang, People’s Republic of China; 3Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
Correspondence: Rui Zhou, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, No. 1279, Sanmen Road, Hongkou District, Shanghai, 200434, People’s Republic of China, Email ruizhoukepler@126.com
Objective: This randomized controlled study aimed to explore the safety and efficacy of a fentanyl-reduced regimen combining esketamine and remimazolam for bronchoscopy in elderly patients.
Methods: A total of 274 elderly patients (aged 65– 85 years, ASA I–III) underwent bronchoscopy in our hospital from September 2024 to May 2025 were randomly divided into two groups: the study group (remimazolam 0.2 mg/kg + esketamine 0.3 mg/kg + fentanyl 0.5 ug/kg) and the control group (remimazolam 0.2 mg/kg + fentanyl 1.5 ug/kg). Remimazolam 0.05 mg/kg was added as needed to maintain sufficient sedation in both groups. The primary outcome was the incidence of procedure-related hypoxemia (SpO2 < 90%). Secondary outcomes included the procedural success rate, recovery metrics (time to awakening, time to discharge, and quality of recovery score), satisfaction levels (patient and endoscopist scores), and adverse events (incidences of hypotension and hypertension, degree of salivation, and body movements like coughing or limb swings).
Results: The study group had a lower incidence of hypoxemia (2.19% vs 9.49%, p = 0.010) and shorter awakening time (17.47 ± 3.10 vs.19.33 ± 3.78, p < 0.001), as well as a higher QoR-15 score (138.95 ± 2.41 vs 137.38 ± 2.70, p < 0.001) compared to the control group. The incidence of hypotension was significantly lower in the study group (0.73% vs 18.25%, p < 0.001). Although the study group exhibited a significantly higher degree of salivation (p < 0.001), no aspiration occurred. There were no significant differences in sedation success rate, discharge time, patient/endoscopist satisfaction, or incidence of agitation between the two groups.
Conclusion: The fentanyl-reduced regimen ensures sedation efficacy, and reduces adverse events like respiratory depression and hypotension, despite increasing salivation. It provides a safer anesthetic option for bronchoscopy in elderly patients.
Keywords: esketamine, remimazolam, fentanyl, hypoxemia, bronchoscopy, elderly patients