The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial

Abstract

Background and Purpose: Data and high-quality studies of anesthetic methods for children with obstructive sleep apnea hypopnea syndrome (OSAHS) who undergo drug-induced sleep endoscopy (DISE) are limited. Research on pediatric DISE using esketamine has never been reported before. To test the safety and efficacy of esketamine during DISE in children with OSAHS, we compare esketamine (Group K) with dexmedetomidine (Group D) in this study.Methods: 100 children with ASA Ⅰ∼Ⅱ grade, prepared for an elective adenotonsillectomy under general anesthesia, were enrolled in this study and randomized into two groups. Midazolam 0.1 mg/kg was administered intravenously for both groups. In Group D a 1 μg/kg bolus of dexmedetomidine was given over 10 min followed by the infusion rate 1 μg/kg/hr to the end of DISE. Group K received a 1.0 mg/kg IV bolus of esketamine over 10 s followed by the infusion rate 1 mg/kg/hr to the end of DISE.Results: Group K had a higher percentage of success than Group D (p = 0.008). The onset time of Group K was shorter than that of Group D (p = 0.000). The University of Michigan Sedation Scale (UMSS) score of Group K was higher than that of Group D (p = 0.005). The risk of adverse effects (AEs) was lower in Group K (p = 0.000). In Group D, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) all decreased, while in Group K, SBP, DBP, and HR hardly changed.Conclusion: Esketamine in comparison to dexmedetomidine provides more effective and safer depth of anesthesia for OSAHS pediatric DISE by ensuring short onset time, deep sedation, and few AEs.Clinical Trial Registration: ClincalTrials.gov, identifier NCT04877639

Recent advances in the study of anesthesia-and analgesia-related mechanisms of S-ketamine

“…The incidence of hypotension and bradycardia is lower when S-ketamine is combined with propofol for sedation and analgesia ( Huang et al, 2023 ), enhancing sedation and reducing both the dose of propofol and propofol-induced injection pain ( Eberl et al, 2020 ; Xu et al, 2022 ). S-ketamine can also shorten the recovery time from anesthesia for painless examinations or operations, with lower respiratory and circulatory-related risks ( Yang et al, 2022 ; Xin et al, 2022 ; Yongping et al, 2022 ; Zheng et al, 2022 ). It is equally safe and effective in pediatric patients ( Zhang et al, 2022 ), and S-ketamine may also reduce the incidence of postoperative agitation as well as delirium in children ( Li et al, 2022 ; Zhang et al, 2022 ; Chen et al, 2023 ).…”