Comparison of anesthetic effects of different sedative drugs combined with remifentanil for general anesthesia in bronchoscopy: a randomized controlled trial
TL;DR
For patients at high risk of hemodynamic instability, etomidate may be preferred with enhanced PONV prophylaxis; for those at high risk of PONV or desiring rapid and comfortable recovery, ciprofol or remimazolam are more suitable options.
Abstract
Electronic bronchoscopy, as an important means of invasive diagnosis, exerts strong stimulation on anatomical structures such as the pharynx, glottis, carina. Therefore, selecting an appropriate anesthesia regimen not only enhances patient comfort and satisfaction but also guarantees the safety and the smooth running of the operation. This study aimed to compare the clinical anesthetic effects of different sedative drugs combined with remifentanil-based general anesthesia in patients undergoing bronchoscopy. A total of 120 patients scheduled for elective painless electronic bronchoscopy were randomly assigned to the ciprofol group (Group C), etomidate group (Group E), and remimazolam group (Group R). The primary observation indicator was the incidence of intraoperative hypotension. Secondary observation indicators included postoperative recovery time and the incidence of perioperative adverse events (such as nausea and vomiting, cough, bronchospasm, dizziness). The incidence of hypotension was 45.0% in Group C, 50.0% in Group R, and 17.9% in Group E. The incidence of hypotension in Group E was significantly lower than that in Groups C and R (χ² = 9.949, P = 0.007). The main perioperative adverse responses were postoperative cough, nausea and vomiting, bronchospasm, and dizziness. There was no statistically significant difference in cough severity among the three groups (χ² = 3.26, P = 0.776). The incidence of postoperative nausea and vomiting (PONV) was 7.50% in Group C, 7.50% in Group R, and 46.15% in Group E. The incidence of PONV in Group E was significantly higher than the other two groups (χ² = 24.331, P < 0.001). No significant differences were observed in recovery time and laryngeal mask removal time across the groups. Etomidate demonstrates superior hemodynamic stability but carries a higher risk of PONV. In contrast, ciprofol and remimazolam offer better postoperative comfort. For patients at high risk of hemodynamic instability, etomidate may be preferred with enhanced PONV prophylaxis; for those at high risk of PONV or desiring rapid and comfortable recovery, ciprofol or remimazolam are more suitable options. Chinese Clinical Trial Registry (ChiCTR2400084332). Registered on May 14, 2024.