Safety and efficacy evaluation of low-dose of esketamine combined with propofol for painless gastroscopy: a single-center, randomized, double-blind, parallel controlled clinical trial.

BACKGROUND

Propofol combined with sufentanil is the most commonly used anesthesia regimen for painless gastroscopy in China. However, this combination carries a higher risk of circulatory and respiratory depression. Esketamine, with its strong analgesic and sympathetic excitatory effects, may be a safer alternative. This study aimed to evaluate the safety and efficacy of propofol-sufentanil versus propofol-esketamine for painless gastroscopy in adults.

METHODS

120 participants were randomly assigned to four groups: PS (propofol 2 mg/kg + sufentanil 0.1 μg/kg), PE1 (propofol 2 mg/kg + esketamine 0.05 mg/kg), PE2 (propofol 2 mg/kg + esketamine 0.1 mg/kg), and PE3 (propofol 2 mg/kg + esketamine 0.2 mg/kg). The primary outcome was the incidence of reflex cough during gastroscopy insertion. Secondary outcomes included hemodynamic changes, pulse oxygen saturation, induction time, recovery time, discharge time, propofol consumption, and the occurrence of adverse events.

RESULTS

There was no significant difference in reflex cough, body movement response, or propofol injection pain between the PS, PE2, and PE3 groups, but these incidences were significantly lower than in the PE1 group (p < 0.05). Hypotension occurred less frequently in PE2 and PE3 compared to PS and PE1 (p = 0.001), with more stable hemodynamics observed in PE2 and PE3. However, the incidence of tachycardia was significantly higher in the PE3 group than in the others (p < 0.05). Fewer participants in PE3 and PS required additional propofol compared to PE1 (p < 0.05), with no significant difference between PS, PE2, and PE3 (p > 0.05). Induction time was significantly shorter in PE3 compared to PS and PE1, with no difference between PE3 and PE2 (p > 0.05). However, recovery time was longest in PE3 (p = 0.002). No significant differences were found in other outcomes (p > 0.05).

CONCLUSION

Considering the superior safety and efficacy observed in the PE2 group, we recommend the combination of 2 mg/kg propofol and 0.1 mg/kg esketamine as the optimal anesthesia for painless gastroscopy. This combination provides several benefits, including reduced reflex cough, stable hemodynamics, and faster recovery, making it a valuable clinical practice.