Subanesthetic-Dose Esketamine Combined with Remimazolam in Non-Intubated Sedated Flexible Bronchoscopy: A Single-Center Retrospective Cohort Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Objective To compare hemodynamic stability, sedative-analgesic consumption, and peri-procedural adverse events between remimazolam-sufentanil sedation with and without low-dose esketamine in patients undergoing non-intubated sedated flexible bronchoscopy. Methods A total of 143 patients undergoing sedated flexible bronchoscopy at Guiyang Second People's Hospital between October and December 2025 were retrospectively enrolled. Based on the anesthetic regimen documented in the anesthesia record, patients were classified into a remimazolam group (Group R) receiving sufentanil 0.1 µg/kg plus remimazolam 0.3 mg/kg, or an esketamine group (Group E) receiving esketamine 0.15 mg/kg followed by the same sufentanil–remimazolam regimen. Thirteen cases were excluded due to additional therapeutic interventions during the procedure, or deviation from the study protocol by the operating physician, resulting in 130 patients finally included in the per-protocol analysis, with 65 patients in each group.Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline (T 0 ), completion of induction (T 1 ), and bronchoscope passage through the glottis (T 2 ). Recovery time, total drug consumption, and incidence of perioperative adverse events were compared between groups. Results At T 0 , MAP and HR were comparable between groups ( p > 0.05); At T 1 , MAP and HR in Group R decreased significantly from baseline, whereas Group E demonstrated significantly higher MAP and HR than Group R (both p < 0.05). At T 2 , Group R exhibited a pronounced sympathetic stress response, with significantly higher MAP and HR compared with Group E (both p < 0.05). The incidences of cough/body movement, hypotension, and hypoxemia in Group E were significantly lower than in Group R (all p < 0.05). Total consumption of remimazolam and sufentanil in Group E was significantly lower than in Group R (both p < 0.001). Recovery time was comparable between groups ( p > 0.05). Conclusion Subanesthetic-dose esketamine added to remimazolam–sufentanil sedation was associated with improved hemodynamic stability, reduced supplemental sedative/analgesic requirements, and fewer cough/body movement and hypotensive events during non-intubated flexible bronchoscopy. These findings should be confirmed in prospective randomized trials.
Source: Research Square
Authors: Jingjie Wang, Luying Deng, Meiyan Liu, Ying Cao
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225320945