Comparison of Esketamine/Propofol and Sufentanil/Propofol on Intraoperative Hypoxemia During Bronchoscopy: A Randomized Trial

Purpose: Propofol and sufentanil are the most commonly used anesthetics during bronchoscopy. Esketamine is an s-enantiomer of ketamine racemate and has both sedative and analgesic effects, it does not inhibit respiration and maintains hemodynamic stability. We aimed to compare the intraoperative hypoxemia risk of esketamine/propofol with sufentanil/propofol for patients in bronchoscopy. Methods: This study was an investigator-initiated, single-center, randomized, double-blind clinical trial. Patients undergoing bronchoscopy were randomly assigned to receive either sufentanil group (n = 33; sufentanil: 0.2 μg/kg) or esketamine group (n = 33; esketamine: 0.2 mg/kg) for sedation and analgesia. Clinical data, anesthetics usage, incidence of intraoperative hypoxemia, total time of hypoxemia, recovery time, and adverse events were recorded. Main Results: The incidence of intraoperative hypoxemia was significantly lower in the esketamine group than in the sufentanil group (27.2% vs 66.7%, P =0.001, OR=5.333, 95% CI=1.859– 15.301). Propofol usage was significantly higher in the esketamine group than in the sufentanil group (t=2.952, P =0.004). The duration of hypoxia was significantly lower in the esketamine group than in the sufentanil group (Z=− 3.445, P < 0.001), and the minimum oxygen saturation (SpO2) was significantly higher than in the sufentanil group (Z=− 2.682, P =0.007). Recovery time from anesthesia was significantly lower in the esketamine group than in the sufentanil group (Z=− 2.709, P =0.007). No difference was found in adverse reactions between the two groups. Conclusion: Esketamine combined with propofol reduced the incidence of intraoperative hypoxemia compared with sufentanil in bronchoscopy. Our results offer the possibility for a novel recommendation for the prevention of intraoperative hypoxemia during bronchoscopy. However, we mentioned the higher propofol use in the esketamine group. Additional clarification is necessary on the indications and the optimal dose of esketamine. Trial Registration: Chinese clinical trial registry: ChiCTR2200058990. Keywords: bronchoscopy, esketamine, hypoxemia, propofol, sufentanil