Effects of Fentanyl-Reduced Regimen with Esketamine and Remimazolam on Bronchoscopy in Elderly Patients.

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.