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

Zheng, Yuling; Xu, Yafei; Huang, Bixin; Mai, Ying; Zhang, Yiwen; Zhang, Zhongqi

doi:10.3389/fphar.2022.956392

Cited by 12 publications

(9 citation statements)

References 32 publications

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“…reported that the synergistic effect of ketamine and propofol could improve the safety and satisfaction of patients and reduce the using dose of drugs during ERCP,. Zhang Zhongqi et al [10]. repoerted that esketamine at 0.3 mg/kg when combined with propofol in gastroscopy not only reduced the risk of cardiovascular and respiratory adverse events, but also provided and analgesia.…”

Section: Discussionmentioning

confidence: 99%

The ED 50 /ED 95 of esketamine in inhibiting body movement when patients undergoing hysteroscopy

Wang,

Li,

Wang

et al. 2024

Preprint

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Background Patients would have a strong discomfort feeling and pain in hysteroscopic surgery because of expanding the cervical canal and tissue stretching. Nowadays, propofol has no analgesic effect, it is necessary to combine other analgesic drugs to inhibit intraoperative body movement and eliminate discomfortable feeling. This study was to explore the half effective dose (ED50) and 95% effective dose (ED95) of esketamine combined with propofol in inhibiting body movement when patients underwent hysteroscopy. Methods 26 patients who needed hysteroscopy were recruited in Haikou Maternal and Child Health Hospital of China. All patients received intravenous esketamine and propofol. The plasma concentration of propofol was set to 3 µg/mL for target-controlled infusion. The dose of esketamine was determined by the Dixon up-and-down sequential method. The ED50/ED95 of esketamine were detected by binary regression (probit). The respiration, circulation and body movement of patients were observed. The operating time, the awakening time and the analgesic effect were recorded. Results The ED50/ED95 of esketamine combined with propofol plasma concetration 3 µg/mL inhibiting body movement in patients with hysteroscopy were 0.391 mg/kg and 0.476 mg/kg, respectively (95% confidence intervals were 0.34–0.431 mg/kg and 0.434–0.778 mg/kg). There are not respiratory and circulatory depression in all patients. Conclusions Esketamine at 0.476 mg/kg which combined with propofol plasma concetration 3 µg/mL showed a good analgesic effect in hysteroscopy.

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Section: Discussionmentioning

confidence: 99%

The ED 50 /ED 95 of esketamine in inhibiting body movement when patients undergoing hysteroscopy

Wang,

Li,

Wang

et al. 2024

Preprint

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“…There was a correlation between these effects and dosage. The propofol dosage was determined according to previous studies [19,20]. In our trial, the propofol TCI model was used to achieve more stable hemodynamics and reduce respiratory depression [21].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of esketamine combined with propofol for curative endoscopic resection in colorectum: A prospective, randomized controlled trial

Ma,

Wang,

Yang

et al. 2023

Preprint

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Background Curative endoscopic resection is widely used to treat colonic polyps and early stage cancers. The anesthetic strategy commonly involves the use of propofol combined with a small dose of opioids for sedation. Adverse respiratory or cardiovascular events such as hypotension often occur when attempting to achieve the necessary level of sedation. Several studies have suggested its advantages owing to the anesthetic, analgesic, and sympathomimetic properties of esketamine. However, there are no reports on curative colorectal endoscopic resection. We designed this randomized controlled trial to assess the efficacy and safety of esketamine combined with propofol for sedation in patients undergoing curative colorectal endoscopic resection. Methods A total of 166 patients who underwent curative colorectal endoscopic resection were randomly assigned to groups A (propofol + fentanyl) or E (propofol + esketamine). Ideal sedation was assessed using the MOAA/S scale and was achieved using TCI-propofol with different doses of fentanyl and esketamine. The propofol consumption and vasoactive drug dosages were recorded. Sedation-related times, adverse events, and satisfaction were recorded. Results Of the 160 patients, the total propofol consumption was significantly lower in group E (n = 81) (300 mg) than in group A (n = 79) (350 mg). Hypotension and bradycardia were significantly lower in Group E than in Group A. The groups showed no significant differences in other adverse events, induction time, recovery time, or patient or endoscopist satisfaction. Conclusion Compared to fentanyl, esketamine helps decrease propofol consumption and increases cardiovascular stability during curative colorectal endoscopic resection in American Society of Anesthesiologists Class I–III patients without affecting anesthesia, patient and endoscopist satisfaction, or other adverse events. Trial registration The study was retrospectively registered at the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2300069014 on 03/03/2023).

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“…ED 50 of propofol was evaluated according to the modified Dixon's up-and-down method (MDUDM) [17]. The previous studies had determined ED 50 of propofol in combination with lidocaine for gastrointestinal endoscopy sedation in adult patients [18] and ED 50 of propofol combined with single dose of ketamine during the UGI endoscopy in elderly patients [19]. As mentioned above, 1.5 mg/kg propofol was set for the first patient in our study.…”

Section: Outcome Endpointsmentioning

confidence: 99%

Effect of esketamine on the ED50 of propofol for successful insertion of ureteroscope in elderly male patients: a randomized controlled trial

Luo,

Hao,

Zhang

et al. 2024

BMC Anesthesiol

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Background Propofol is effective and used as a kind of routine anesthetics in procedure sedative anesthesia (PSA) for ureteroscopy. However, respiratory depression and unconscious physical activity always occur during propofol-based PSA, especially in elderly patients. Esketamine has sedative and analgesic effects but without risk of cardiorespiratory depression. The purpose of this study is to investigate whether esketamine can reduce the propofol median effective dose (ED50) for successful ureteroscope insertion in elderly male patients. Materials and methods 49 elderly male patients undergoing elective rigid ureteroscopy were randomly divided into two groups: SK Group (0.25 mg/kg esketamine+propofol) and SF Group (0.1 µg/kg sufentanil+propofol). Patients in both two groups received propofol with initial bolus dose of 1.5 mg/kg after sufentanil or esketamine was administered intravenously. The effective dose of propofol was assessed by a modified Dixon’s up-and-down method and then was adjusted with 0.1 mg/kg according to the previous patient response. Patients’ response to ureteroscope insertion was classified as “movement” or “no movement”. The primary outcome was the ED50 of propofol for successful ureteroscope insertion with esketamine or sufentanil. The secondary outcomes were the induction time, adverse events such as hemodynamic changes, hypoxemia and body movement were also measured. Result 49 patients were enrolled and completed this study. The ED50 of propofol for successful ureteroscope insertion in SK Group was 1.356 ± 0.11 mg/kg, which was decreased compared with that in SF Group, 1.442 ± 0.08 mg/kg (P = 0.003). The induction time in SK Group was significantly shorter than in SF Group (P = 0.001). In SK Group, more stable hemodynamic variables were observed than in SF Group. The incidence of AEs between the two groups was not significantly different. Conclusion The ED50 of propofol with esketamine administration for ureteroscope insertion in elderly male patients is 1.356 ± 0.11 mg/kg, significantly decreased in comparsion with sufentanil. Trial registration Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn.

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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

Cited by 12 publications

References 32 publications

The ED 50 /ED 95 of esketamine in inhibiting body movement when patients undergoing hysteroscopy

The ED 50 /ED 95 of esketamine in inhibiting body movement when patients undergoing hysteroscopy

Efficacy and safety of esketamine combined with propofol for curative endoscopic resection in colorectum: A prospective, randomized controlled trial

Effect of esketamine on the ED50 of propofol for successful insertion of ureteroscope in elderly male patients: a randomized controlled trial

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