Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

Abstract

Purpose Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy. Patients and Methods A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded. Results Propofol consumption was 274.4±22.6 mg and 201.3±16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4±2.3 s and 17.8±1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2±1.1 min and 4.8±1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58±0.49 vs 3.71±0.83) and (4.75±0.44 vs 3.33±0.92), respectively. Conclusion The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application. Clinical Trials Registration ChiCTR 2200062547.

Effect of Esketamine Added to Propofol Sedation on Desaturation and Hypotension in Bidirectional Endoscopy

“…Forty-one patients (12.4%) in the esketamine group and 55 (16.7%) in the placebo group had hypertension (SMD, 0.12). The median (IQR) procedure time was 20 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) minutes in the esketamine group and 18 (15)(16)(17)(18)(19)(20)(21)(22) minutes in the placebo group (SMD, 0.15).…”

“…Eberl et al 22 enrolled 162 patients undergoing endoscopic retrograde cholangiopancreatography and demonstrated that esketamine (0.15 mg/kg) led to reduced propofol requirements compared with alfentanil (2 μg/kg), without affecting recovery time or adverse events. Another study, 24 which involved 114 patients with obesity undergoing gastroscopy, found that the combination of propofol and esketamine (0.25 mg/kg) resulted in a shorter induction time and awakening time, lower propofol consumption, more stable hemodynamics, and a reduced incidence of adverse events compared with propofol alone. Specifically, the incidence of hypoxemia was 17.3% in the esketamine group vs 40.4% in the control group, and the incidence of hypotension was 7.7% in the esketamine group vs 23.1% in the control group.…”