The median effective concentration of propofol with different doses of esketamine during gastrointestinal endoscopy in elderly patients: A randomized controlled trial

Abstract

Aims Propofol may result in hypotension, bradycardia and loss of protective reflexes, especially in elderly patients, while esketamine, a N‐methyl‐D‐aspartate receptor antagonist, has analgesic, anaesthetic and sympathomimetic properties and is known to cause less cardiorespiratory depression. We hypothesized that esketamine may reduce the median effective concentration (EC50) of propofol and coadministration is less likely to produce hypotension during gastrointestinal endoscopy in elderly patients. Methods Ninety elderly patients, aged 65–89 years, undergoing gastrointestinal endoscopy were randomly assigned into 3 groups: SK0 (control) group (0 mg/kg esketamine); SK0.25 group (0.25 mg/kg esketamine); and SK0.5 group (0.5 mg/kg esketamine). Anaesthesia was achieved by plasma target‐controlled infusion of propofol with different bolus doses of esketamine. The EC50 of propofol for gastrointestinal endoscopy was determined by using the up‐and‐down method of Dixon. The initial plasma target concentration is 2.5 μg/mL and the adjacent concentration gradient is 0.5 μg/mL. Cardiovascular variables were also measured. Results Propofol EC50s and its 95% confidence interval for gastrointestinal endoscopy in elderly patients were 3.69 (2.59–4.78), 2.45 (1.85–3.05) and 1.71 (1.15–2.27) μg/mL in the SK0, SK0.25 and SK0.5 groups, respectively (P < .05). The average percent change from baseline mean arterial pressure was −19.7 (7.55), −15.2 (7.14) and −10.1 (6.73), in the SK0, SK0.25 and SK0.5 groups, respectively (P < .001). Conclusion Combination medication of propofol with esketamine reduced the propofol EC50 during gastrointestinal endoscopy in elderly patients compared with administration of propofol without esketamine. Increasing doses of SK with propofol are less likely to produce hypotension with shorter recovery time.

Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial

“…Tristimania 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1.000 [15] also reported the effectiveness of esketamine as an adjunct to propofol target-controlled infusion for gastrointestinal endoscopy in elderly patients. Eberl and colleagues found that this combination was also effective in Endoscopic retrograde cholangiopancreatography (ERCP).…”

“…This result showed the efficacy of the subanesthetic dose of esketamine–propofol combination during GI endoscopy sedation. Yang et al [ 15 ] also reported the effectiveness of esketamine as an adjunct to propofol target-controlled infusion for gastrointestinal endoscopy in elderly patients. Eberl and colleagues found that this combination was also effective in Endoscopic retrograde cholangiopancreatography (ERCP).…”

“…However, SBP, DBP, and HR decreased immediately after administration of induction and increased to the baseline value at the time before patients left the operating room in all four groups. In contrast, another study showed that the combination of esketamine and propofol caused more stable hemodynamics [ 15 ]. The doses of esketamine in that study were 0.25 mg/kg and 0.5 mg/kg, which are relatively higher than the concentrations in our study.…”

“…Eberl et al [ 16 ] also found no differences in the incidence of adverse events with low-dose esketamine combined with propofol compared with alfentanil combined with propofol for ERCP. Yang’s study did not find significant clinical complications and psychotomimetic effects of the coadministration of a relatively high dose of esketamine and propofol for the procedure of gastrointestinal endoscopy [ 15 ].…”

Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial

“…Many patients could not tolerate a bronchoscopic procedure without sedation for anxiety and intense stimulation. While the frequently reported regimens include an opioid/propofol combination, other authors [ 26 , 27 ] have suggested that esketamine may be both safe and effective for short surgery. Although previous studies on the safety and validity of esketamine in bronchoscopy are scarce, several studies have demonstrated the effectiveness of ketamine in bronchoscopy, especially for pediatric patients [ 28 , 29 ].…”