Esketamine vs. sufentanil for anesthesia induction in elderly patients undergoing transbronchial lung biopsy (TBLB): effect on hemodynamic stability, airway reactivity, and oxygenation.

BACKGROUND: Elderly patients undergoing transbronchial lung biopsy (TBLB) face anesthesia-associated complications from cardiopulmonary impairment and comorbidities, so geriatric TBLB anesthetic management is crucial. AIM: To compare esketamine and sufentanil on hemodynamics, airway pressure, bronchospasm incidence and oxygenation in elderly TBLB induction. METHODS: Using a retrospective propensity score matching (PSM) cohort study design, We enrolled recruited elderly patients undergoing TBLB at the Hospital between January 2024 and August 2025. Patients were divided by anesthesia induction protocol: control group (Group S, sufentanil combination) and experimental group (Group E, esketamine combination). A 1:1 PSM method was used to match 40 patients in each group. Primary outcomes included heart rate (HR), mean arterial pressure (mBP), blood oxygen saturation (SpO₂) and airway pressure (Paw) at the time of entering the operating room (T0), LMA insertion (T1), bronchoscopic biopsy (T2), the end of operation (T3), and LMA removal (T4). The incidence of bronchial smooth muscle spasm was observed under the microscope. Secondary outcomes were extubation time, recovery time, and PONV incidence. RESULTS: After PSM, baseline characteristics were comparable (P>0.05). At time points of high stimulation (T1, T2), Group E had significantly higher HR and mBP than Group S (P<0.05). This translated to a markedly lower incidence of clinically significant hypotension requiring intervention in Group E (12.5% vs. 45.0%, P = 0.001). Group E also exhibited significantly lower Paw at T1-T3, higher SpO₂ at T2, and a markedly reduced incidence of bronchospasm (5.0% compared to 22.5%, P<0.05). Recovery profiles favored Group E, showing shorter extubation and recovery times alongside a lower incidence of PONV (P<0.05). CONCLUSIONS: In this retrospective study, esketamine showed associations with improved hemodynamic stability, lower incidence of bronchospasm and airway pressure, reduced PONV, and better oxygenation during induction in elderly TBLB patients, suggesting its potential as a viable alternative.