ED ₅₀ and ED ₉₅ of propofol combined with different doses of esketamine for children undergoing upper gastrointestinal endoscopy: A prospective dose‐finding study using up‐and‐down sequential allocation method

Abstract

What is known and objective: Propofol and esketamine are routine anaesthetics used in sedation or general anaesthesia for paediatric procedures. Coadministration could reduce the dose of either propofol or esketamine required and lower the incidence of drug-related adverse events. We designed a four-arm randomized controlled trial in children undergoing diagnostic upper gastrointestinal endoscopy to investigate the dose of propofol with different doses of esketamine inducing appropriate depth of anaesthesia in 50% patients (median effective dose, ED 50 ).Methods: After getting the approval of the research ethics committee and informed consent, 92 paediatric patients planning for upper gastrointestinal endoscopy were divided into four groups randomly: esketamine 0, 0.25, 0.5 and 1 mg/kg groups (n = 23/group). Propofol doses followed the Dixon and Massey up-and-down method with different starting and interval doses between groups. During the first attempt of endoscope insertion, if patients' reactions prevented the insertion, it would be considered as a failure. The awakening time, total propofol doses, as well as the perioperative and post-procedure adverse events were evaluated and recorded for each patient. Results and discussion:The ED 50 (median, 95% confidence interval) of propofol was significantly greater in esketamine 0 and 0.25 mg/kg groups in comparison with the esketamine 0.5 and 1 mg/kg groups (4.

Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy: a randomized trial

“…These results showed that the combination of propofol and esketamine could reduce the dosage of propofol without affecting the anesthetic effect. A clinical study on cholangiopancreatography also found that the combination of propofol and esketamine could reduce the total amount of propofol required without affecting the time to recovery [23].…”

Median effective dose (ED 50 ) of esketamine combined with propofol for children to inhibit response of gastroscope insertion

“…The recommended dose of esketamine for intravenous anesthesia is 1.0-1.5 mg/kg [7] , which, however, results in a marked increase in HR and blood pressure in children during clinical use, suggesting that esketamine is unsuitable for intravenous anesthesia in children alone. The combined use of different concentrations of esketamine (0, 0.25, 0.5, and 1 mg/kg) for gastroscopy in children greatly reduces the amount of used propofol, but 1 mg/kg esketamine will signi cantly intensify side effects [3] . Our study found that the 3 mg/kg propofol combined with low-dose esketamine could effectively avoid the occurrence of related side effects.…”

“…Some studies have explored the dose of propofol in combination with different doses of esketamine used in pediatric painless gastroscopy. Zheng XS [3] and J. Hayes [17] evaluated four doses of ketamine adjunct to propofol. Abandoning their primary target ED 50 of propofol, they found that 1 mg/kg esketamine enhanced the incidence of nausea and visual disturbances.…”

“…If the child had hypotension (systolic blood pressure below 30% of baseline), 3-6 mg of ephedrine was administered. After the examination, the modi ed Aldrete scale was used to assess the departure of patients from the recovery room only if they reached a score of nine points or more [3] .…”

Effective dose of propofol combined with a low-dose esketamine for gastroscopy in elderly patients: A dose finding study using dixon’s up-and-down method

“…Like Ketamine, esketamine is an N-methyl-D-aspartate receptor antagonist with analgesic, anesthetic, and sympathomimetic properties and can reduce the incidence of cardiopulmonary depression; however, there is a correlation between effect and dosage, and a small dose of esketamine has greater sedative and analgesic effects than a larger dose ( Perez-Ruixo et al, 2021 ; Yang et al, 2022b ; Zheng et al, 2022 ). Esketamine can be used safely and effectively in elderly patients due to its stable hemodynamics and low incidence of adverse events properties ( Yang et al, 2022b ).…”