4. Discussion
sedative-related adverse, cough, hypoxemia, hallucinations, laryngospasm, glottis, increases cardiac output, hallucination, cough reaction
LARYNGOSPASM, ADVERSE EFFECTS, ASTHMA, SYMPATHOMIMETIC, LARYNGEAL SPASMS
In this study, we explored the efficacy and safety of a subclinical dose of esketamine used for deep sedation in the EBUS-TBNA procedure. The results demonstrated that using esketamine in combination can improve the sedative effect, reduce the cough reaction, and maintain more stable blood pressure to some extent. However, we did not observe a reduction in the incidence of sedative-related adverse events.Endoscopists usually spray local anesthetic through the bronchoscope during bronchoscopy to improve patient tolerance and reduce cough rate [Esketamine has sympathomimetic effects and increases cardiac output in a dose-dependent manner [Schlatter et al. reported that 42 patients occurred hypoxemia (SpOThe side effects of esketamine include laryngeal spasms, increased airway secretion, hallucinations, nightmares, and other mental symptoms, which limit its application in adult bronchoscopy sedation. To reduce these adverse effects, all patients were given penehyclidine hydrochloride before the procedure to suppress gland production and a modest dosage of midazolam to prevent esketamine-related mental symptoms. Both oropharyngeal topical anesthesia and transtracheal administration were performed to reduce laryngeal sensitivity. One laryngospasm and one hallucination were found in our study. The patient with laryngospasm had a history of asthma, and the bronchoscope passed through the glottis four times during the procedure, which may be the reason for the laryngospasm. Also, the patient with hallucination was a young male with a large weight, similar to the patient with hallucination observed by Dal et al. [Our research has limitations as well. First, esketamine can increase the bispectral index (BIS) value for its influence on brain waves [In conclusion, esketamine combined with propofol TCI deep sedation for EBUS-TBNA can to some extent produce better sedation and more stable blood pressure than propofol TCI alone. The coughing reaction can also be reduced. No reduction in the occurrence of sedation-related side effects was observed.