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SUMMARYPropofol has several attractive properties that render it a potential alternative sedative agent for endoscopy. Compared with meperidine and midazolam, it has an ultra-short onset of action, short plasma half-life, short time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. Shorter times to achieve sedation enhance efficiency in the endoscopy unit. Multiple studies have documented the safe administration of propofol by non-anaesthesiologists. Administration by registered nurses is more cost-effective than administration by anaesthesiologists. However, the administration of propofol by a registered nurse supervised only by the endoscopist is controversial because the drug has the potential to produce sudden and severe respiratory depression. More information is needed on how training nurses and endoscopists should proceed to give propofol, as well as the optimal level of monitoring to ensure the safety of nurse-administered propofol. INTRODUCTIONThe pattern of sedation use for endoscopic procedures varies between countries more than any other aspect of endoscopic practice. These differences probably reflect cultural variation in the expectations of patients and the beliefs and preferences of endoscopists. Many patients prefer sedation, however, and sedation is routine in some countries, including the USA.1-4 The routine sedative agents for gastrointestinal endoscopic procedures include a combination of benzodiazepines and narcotic analgesics. [5][6][7] Since its introduction in 1986, midazolam has become the most commonly chosen benzodiazepine for sedation. [7][8][9] It is a powerful anxiolytic agent, 10 which facilitates relaxation and patient co-operation. From an endoscopic perspective, it also has other useful properties, including antegrade amnesia and a short elimination half-life. Moreover, the cardiopulmonary effects of this agent are relatively minimal when the use of adjunctive agents is minimized. 9 With the addition of an opiate, the sedative and amnestic properties of midazolam are synergistically enhanced, thereby optimizing patient satisfaction. 3Unfortunately, there are potential problems with the use of both benzodiazepines and narcotic analgesics. These include a variable onset of action, 5, 11 postprocedure residual effects that may delay the time to discharge and an increased risk of respiratory depression, particularly in the elderly population. 12 In certain groups of patients, e.g. alcoholics and chronic users of benzodiazepines or narcotics, the efficacy of midazolam and narcotics may be limited. 13The ideal agent for sedation should have the following properties: rapid onset of action, analgesic and anxiolytic effects, immediate resolution of sedation without any lingering effects on mental and psychomotor functions, amnestic period long enough for the procedure and minimal associated risks or adverse effects. 3,7

Background: Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery. Materials and methods: The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg −1 , and when the Modified Observer’s Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg −1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events. Results: A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg −1 (95% CI 1.95–2.01 mg·kg −1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10–24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations. Conclusion: The ED 95 of intranasal esketamine with 0.5 mg·kg −1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg −1 . For children aged 2–6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.