Objective  To explore the effect of esketamine combined with propofol on hemodynamic stability and recovery quality in the early stage after operation in patients with painless fiberoptic bronchoscopy.

  Methods  A total of 60 patients with painless fiberoptic bronchoscopy were selected and randomly divided into esketamine group and fentanyl group, with 30 cases in each group. During anesthesia induction, the esketamine group was slowly injected with 0.3 mg/kg of esketamine and 2.5 mg/kg of propofol, while the fentanyl group was given fentanyl 1.0 μg/kg combined with propofol 2.5 mg/kg. The mean arterial pressure (MAP), heartrate (HR), pulse oxygen saturation (SpO₂) and bispectral index (BIS) were compared at time points of before anesthesia induction (T₁), after laryngeal mask placement (T₂), immediately after fiberoptic bronchoscopy entry (T₃) and immediately after fiberoptic bronchoscopy examination (T₄) between two groups; the Quality of Recovery Scale (QoR-40) was performed at 1 day before operation (T₀) and 1 day after operation (T₅); the dosage of propofol and the incidence of adverse events were recorded in both groups.

  Results  At T₂, the MAP, HR and SpO₂ in the esketamine group were significantly higher than those in the fentanyl group (P < 0.05); compared with T₁, the MAP and HR decreased significantly at T₂ in the fentanyl group, SpO₂ level decreased significantly in both groups, and the decrease range of SpO₂ was significantly greater in the fentanyl group (P < 0.05); compared with T₂, the MAP and HR at T₃ in both groups increased significantly, SpO₂ in the fentanyl group increased significantly, and the MAP at T₃ in the esketamine group was significantly higher than that in the fentanyl group (P < 0.05); the MAP and HR at T₄ in both groups were significantly higher than those at T₃ in the same group (P < 0.05); at T₅, scores of the physical comfort, emotional state, psychological support and pain score as well as total score in the esketamine group were significantly higher than those in the fentanyl group (P < 0.05); the total dose of propofol in the esketamine group was (277.67±21.28) mg, which was significantly less than (290.33±24.98) mg in the fentanyl group (P < 0.05). The incidence of pain due to propofol injection and apnea in the esketamine group was significantly lower than that in the fentanyl group (P < 0.05); there were no significant differences in the incidence rates of choking cough, nausea and vomiting between the two groups (P>0.05), but the number of cases in the esketamine group was less; all the patients had no hallucinations.

  Conclusion  Compared with fentanyl, the patients'intraoperative vital signs are more stable when esketamine is used for painless fiberoptic bronchoscopy, the recovery quality in early stage after operation is improved significantly, and the incidence of adverse events is lower.