Pakistan Journal of Pharmaceutical Sciences

Abstract: Objectives: To compare the impact of titrated versus fixed-dose remifentanil infusion on hemodynamic variability, sedation quality, and peri-procedural complications in elderly patients undergoing elective bronchoscopy. Methods: This retrospective study included 130 patients aged ?65 years who underwent elective bronchoscopy under remifentanil sedation. Patients were randomized into a titrated-dose group (Group A) and a fixed-dose group (Group B). Hemodynamic indices—including mean arterial pressure (MAP) and heart rate (HR)—were recorded at eight predefined time points (T0–T7) using CNBP monitoring. The primary outcomes were MAP and HR variability across time intervals. Secondary outcomes included incidence of hypotension, bradycardia, and desaturation; sedation depth assessed with the Ramsay Sedation Scale (RSS); additional sedative requirements; and recovery time. Logistic regression was performed to identify predictors of hemodynamic instability. Results: Group A demonstrated significantly lower MAP and HR variability compared with Group B, along with fewer hypotensive events (9.2% vs. 23.1%, p = 0.034). Sedation adequacy was superior in Group A (RSS 2.6 ± 0.3 vs. 2.2 ± 0.4, p < 0.001), and recovery time was shorter (14.3 ± 3.7 vs. 16.9 ± 4.1 min, p = 0.002). Incidences of bradycardia and oxygen desaturation were also reduced. Logistic regression identified higher MAP/HR variability and fixed-dose remifentanil as independent predictors of hemodynamic instability. Conclusion: Titrated remifentanil infusion guided by CNBP monitoring enhances cardiovascular stability, optimizes sedation depth, and accelerates recovery in elderly patients undergoing bronchoscopy. These findings support adopting individualized remifentanil titration protocols to minimize hemodynamic complications in geriatric sedation practice.