{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:01:47Z","timestamp":1785391307830,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Purpose<\/jats:title>\n To investigate the efficacy and safety of remimazolam combined with ultrasound-guided superior laryngeal nerve block (SLNB) during bronchoscopic procedures in elderly patients with coronary heart disease.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 99 elderly patients with coronary heart disease who underwent a flexible bronchoscopy procedure at the First Hospital of Shanxi Medical University from March 2025 to August 2025 were enrolled and randomly divided into three groups (\n n<\/jats:italic>\n = 33 each): Group R (remimazolam plus topical anesthesia), Group RSL (remimazolam plus topical anesthesia plus SLNB), and Group PSL (propofol plus topical anesthesia plus SLNB). Hemodynamic parameters (MAP, HR, SpO\n 2<\/jats:sub>\n ) were recorded at five time points: before oxygen inhalation after entering the operating room (T0), after anesthesia induction (T1), bronchoscope passage through the vocal cords (T2), at the end of the procedure (T3), and immediately upon leaving the operating room (T4). Cognitive function (MMSE, MoCA, SAS, SDS) was assessed at three time points: 1 h preoperatively (d0), 1 day postoperatively (d1), and 7 days postoperatively (d7). Inflammatory and stress markers (TNF-\u03b1, CRP, and COR) were measured at two time points: preoperatively (T0) and upon leaving the operating room (T4). Anesthesia outcomes and adverse events were also compared. Longitudinal outcomes were analyzed using linear mixed-effects models, with repeated-measures ANOVA performed as a sensitivity analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n No significant differences were observed in baseline characteristics among the three groups (\n P<\/jats:italic>\n &gt; 0.05). Hemodynamic parameters showed no significant differences at T0, T1, or T4 (\n P<\/jats:italic>\n &gt; 0.05). However, at T2 and T3, MAP and HR in Group R were significantly higher than those in Group RSL and Group PSL (\n P<\/jats:italic>\n &lt; 0.001), while SpO\n 2<\/jats:sub>\n was significantly lower (\n P<\/jats:italic>\n &lt; 0.001). No significant differences in MAP or HR were found between Group RSL and Group PSL at T2 or T3 (\n P<\/jats:italic>\n &gt; 0.05), but SpO\n 2<\/jats:sub>\n was higher in Group RSL than in Group PSL (T2:\n P<\/jats:italic>\n = 0.003; T3:\n P<\/jats:italic>\n = 0.004). Regarding cognitive function, no significant differences were observed between Group R and Group PSL at any time point (\n P<\/jats:italic>\n &gt; 0.05). At d1, MMSE and MoCA scores in Group RSL were higher than those in Group R and Group PSL (\n F<\/jats:italic>\n = 6.54,\n P<\/jats:italic>\n = 0.002;\n F<\/jats:italic>\n = 7.51,\n P<\/jats:italic>\n = 0.001), while SAS and SDS scores were lower (\n F<\/jats:italic>\n = 6.69,\n P<\/jats:italic>\n = 0.002;\n F<\/jats:italic>\n = 4.64,\n P<\/jats:italic>\n = 0.012). CRP levels showed no significant differences across groups at any time point (\n P<\/jats:italic>\n &gt; 0.05). At T4, TNF-\u03b1 and COR levels differed significantly among the three groups (\n F<\/jats:italic>\n = 8.75,\n P<\/jats:italic>\n &lt; 0.001;\n F<\/jats:italic>\n = 5.16,\n P<\/jats:italic>\n = 0.007), with Group R showing significantly higher levels than Group RSL and Group PSL (\n P<\/jats:italic>\n &lt; 0.05), whereas no significant differences were detected between Group RSL and Group PSL (\n P<\/jats:italic>\n &gt; 0.05). In terms of anesthesia outcomes, Group RSL and Group PSL had a higher proportion of vocal cord opening, greater patient and endoscopist satisfaction (\n P<\/jats:italic>\n &lt; 0.001,\n P<\/jats:italic>\n = 0.015), shorter recovery time (\n F<\/jats:italic>\n = 4.64,\n P<\/jats:italic>\n = 0.010), and lower intraoperative remifentanil consumption (\n F<\/jats:italic>\n = 35.42,\n P<\/jats:italic>\n &lt; 0.001) compared with Group R. Recovery time was shorter in Group RSL than in Group PSL. However, the difference was not statistically significant (\n P<\/jats:italic>\n &gt; 0.05). Regarding adverse events, the incidence of intraoperative coughing, hypoxemia, and postoperative nausea and vomiting was significantly higher in Group R than in Group RSL and Group PSL (\n P<\/jats:italic>\n &lt; 0.05). Group RSL had a lower incidence of intraoperative hypoxemia than Group PSL (\n P<\/jats:italic>\n = 0.046). No block-related complications were observed in Group RSL or Group PSL.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Ultrasound-guided superior laryngeal nerve block combined with remimazolam for bronchoscopy in elderly patients with coronary heart disease helps maintain hemodynamic stability, suppresses coughing, reduces adverse reactions, shortens recovery time, lowers remifentanil consumption and hypoxemia incidence, and enhances anesthesia satisfaction, suggesting that this regimen may be a feasible option for bronchoscopy sedation. Although transient differences in early postoperative cognitive screening scores were observed, their clinical significance remains unclear and warrants cautious interpretation.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1840825","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:40:36Z","timestamp":1785390036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical study of remimazolam combined with ultrasound-guided superior laryngeal nerve block in elderly patients with coronary heart disease undergoing bronchoscopy"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuqian","family":"Sang","sequence":"first","affiliation":[{"name":"School of Anesthesiology, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Wu","sequence":"additional","affiliation":[{"name":"School of 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