Median effective dose (ED50) of esketamine combined with different doses of propofol for children to inhibit the response to gastroscope insertion: a prospective dose-response clinical study.

BACKGROUND: This study aimed to evaluate whether combining esketamine with different doses of propofol could reduce drug requirements and minimize adverse effects in children undergoing gastroscopy. METHODS: Eighty-eight children scheduled for painless gastroscopy were randomly assigned to four groups receiving propofol at doses of 1, 2, 3, or 4 mg/kg. Esketamine was administered using the Dixon up-and-down sequential method. Failure was defined as coughing, gagging, or airway obstruction during initial gastroscope insertion. The median effective dose (ED50) and 95% confidence intervals were calculated using the up-and-down method and probit regression analysis. RESULTS: The ED50 of esketamine decreased significantly with increasing doses of propofol. The ED50 of esketamine combined with propofol 4 mg/kg was significantly lower than that observed with propofol doses of 1, 2, and 3 mg/kg (P < 0.001), and the ED50 with propofol 3 mg/kg was significantly lower than that with propofol 1 and 2 mg/kg (P < 0.05). Recovery time was significantly longer in the propofol 2, 3, and 4 mg/kg groups compared with the 1 mg/kg group, and the incidence of hypotension was higher in the propofol 4 mg/kg group. During recovery, children receiving propofol 1 mg/kg experienced a higher incidence of delirium and visual disturbances. No significant differences were observed in examination time, physician satisfaction, or respiratory depression among the groups. CONCLUSION: Combining esketamine with propofol reduced the esketamine dose required for pediatric gastroscopy in a propofol dose-dependent manner. Among the regimens studied, esketamine combined with 2 mg/kg propofol appears to provide a more favorable balance between anesthetic efficacy and safety.