The effectiveness of esketamine and propofol versus dezocine and propofol sedation during gastroscopy: A randomized controlled study

Abstract

What Is Known and Objective Propofol is widely used in painless gastroscopy. However, sedation with propofol alone might increase the risk of respiratory and circulatory complications. This randomized clinical study compares the efficacy and safety of esketamine or dezocine combined with intravenous (IV) propofol in patients undergoing gastroscopy. Methods A total of 102 patients were enrolled in this study and randomized into two groups. All patients were adults aged 18–64 years who underwent upper gastrointestinal gastroscopy. Patients were randomly assigned to two groups to receive esketamine (0.3 mg/kg) combined with propofol (group E) or dezocine (0.05 mg/kg) combined with propofol (group D). In both groups, the drugs were administered intravenously. The primary outcome was the dose of propofol which provided a satisfactory sedative effect, both to the endoscopist and the patients. Secondary outcomes included recovery time, side effects (such as hypotension, nausea and vomiting and agitation), and the number of adverse circulatory and respiratory events. Results Data of 83 patients were analysed in the present study. Dosage of propofol required in group E (1.44 mg/kg ± 0.67 mg/kg) was significantly lower compared with that in group D (2.12 mg/kg ± 0.37 mg/kg) (p < 0.0001). There was no statistically significant difference in recovery time, side effects, and the frequency of sedation‐related adverse events between the two groups. What Is New and Conclusion The study indicates that intravenous injection of propofol and esmketamine is more effective for gastroscopy. Use of esketamine reduces the total amount of propofol required in ASA I–II patients undergoing gastroscopy compared with single use of dezocine. It also provides more stable hemodynamics, without affecting the recovery time and side effects such as respiratory and circulatory adverse events. Trial Registration The study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn; registration number: ChiCTR2100051814) on 05/10/2021.

The median effective concentration of propofol in combination with different doses of esketamine during gastrointestinal endoscopy in adults

“…Propofol is often used in combination with ketamine and opioids to improve efficacy and patient tolerance. Several studies ( Wang et al, 2019 ; Eberl et al, 2020 ; Huang et al, 2022 ; Xu et al, 2022 ) have compared a single-dose combination of esketamine and propofol with propofol and other types of drugs in terms of side effects and degree of sedation undergoing minor procedures, withesketamine doses ranged from 0.15 to 0.5 mg/kg. Esketamine (0.5 mg/kg) has been proven to be safe and well tolerated in Chinese patients undergoing painless gastroscopy, with no serious adverse events ( Wang et al, 2019 ).…”

Effects of Remimazolam Combined with Esketamine Anesthesia on Circulatory and Respiratory Function during Painless Gastroenteroscopy

“…(2) e circulatory and respiratory functions of the two groups before and after anesthesia were compared. (3) e adverse reactions during the progress of examination/procedure were compared between the two groups. (4) e complications after examination/operation were compared between the two groups.…”

“…However, the effects of different drugs used in clinical practice vary, so it has been a focus of attention for anesthesiologists to choose a reasonable combination of anesthetic drugs for painless gastroenteroscopy to facilitate rapid recovery, improve intraoperative safety, and reduce the incidence of complications. Propofol is an intravenous anesthetic that is characterized by the rapid onset of action, short duration of action, and no accumulation in a short time, but it is prone to causing hypotension and respiratory depression which can occur at high doses [3]. Sufentanil is a commonly used opioid analgesic with strong analgesic efficacy which can reduce the amount of intraoperative sedation, but is prone to adverse effects such as respiratory depression and nausea [4].…”

Remimazolam tosilate has a lower incidence of hypotension than propofol in painless colonoscopy

“…Propofol, as the preferred drug for gastrointestinal endoscopy anesthesia, has the satis ed sedation effect, but its side effects are obvious, including pain of injection, and dose-dependent circulation and respiration inhibition [13][14][15][16] ] . The combination of propofol and ketamine or opioids can signi cantly reduce the dose of propofol, thus producing less incidence of adverse circulatory and respiratory events [17,18]. Therefore, propofol has great shortcomings in the patients with cardiopulmonary insu ciency.…”