Liu Cuicui, Wang Yanting, Yin Yanwei, Wang Pei, Ji Xiangyu, Sun Jian, Zhao Shuo, Jia Yanfang, Liu Shanling, Zhou Zangong
Daytime Anesthesiology Department, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China.
Pain Department, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China.
J Pain Res. 2025 Jan 15;18:205-215. doi: 10.2147/JPR.S498499. eCollection 2025.
This randomized, controlled trial aimed to assess the sedative effects of esketamine and sufentanil combined with propofol during EUS.
Three hundred and forty patients undergone EUS were randomly divided into two groups to receive esketamine 0.25 mg/kg combined with propofol (esketamine group) or sufentanil 0.1 μg/kg combined with propofol (sufentanil group). The primary outcome measure was respiratory depression incidence. The secondary outcomes included the incidence of body movements, propofol dosage, lowest SPO during the operation, and management of airway obstruction. In addition, other procedures and anesthesia-related outcomes, and postoperative complications were recorded.
A total of 340 patients underwent randomization. Of these, 172 were assigned to the esketamine group and 168 were assigned to the sufentanil group. 1 patient in the esketamine group was lost in the follow-up. During the EUS, 9 patients (5.3%) in the esketamine group and 26 (15.5%) in the sufentanil group developed respiratory depression; this difference was statistically significant ( = 0.002). Regarding secondary outcomes, the incidence of body movements, induction dosage, supplemental times, and total dosage of propofol were much higher in the sufentanil group than in the esketamine group ( < 0.05). In addition, the lowest SPO during the operation, occurrence rate of airway intervention, and management of airway obstruction were significantly different ( < 0.05). Compared to the sufentanil group, the induction time of sedation in the esketamine group was shorter, and the hemodynamics were more stable ( < 0.05). In addition, there were significant differences in the PACU incidence rates of nausea or vomiting between the two groups ( < 0.05), whereas the following day's complications showed no statistical difference.
Esketamine combined with propofol for sedation during EUS can decrease respiratory depression, reduce the dosage of propofol and PONV, and provide a more stable hemodynamic state. Consequently, esketamine could be considered as a potential alternative to sufentanil for sedation during EUS.
本随机对照试验旨在评估艾司氯胺酮和舒芬太尼联合丙泊酚在超声内镜检查（EUS）期间的镇静效果。
340例行EUS的患者被随机分为两组，分别接受0.25mg/kg艾司氯胺酮联合丙泊酚（艾司氯胺酮组）或0.1μg/kg舒芬太尼联合丙泊酚（舒芬太尼组）。主要观察指标为呼吸抑制发生率。次要观察指标包括身体活动发生率、丙泊酚用量、手术期间最低脉搏血氧饱和度（SPO）以及气道梗阻的处理情况。此外，记录其他操作及麻醉相关结局和术后并发症。
共有340例患者进行了随机分组。其中，172例被分配至艾司氯胺酮组，168例被分配至舒芬太尼组。艾司氯胺酮组有1例患者在随访中失访。在EUS期间，艾司氯胺酮组有9例患者（5.3%）发生呼吸抑制，舒芬太尼组有26例患者（15.5%）发生呼吸抑制；差异具有统计学意义（P = 0.002）。关于次要观察指标，舒芬太尼组的身体活动发生率、丙泊酚诱导剂量、追加次数和总用量均显著高于艾司氯胺酮组（P < 0.05）。此外，手术期间最低SPO、气道干预发生率和气道梗阻处理情况也存在显著差异（P < 0.05）。与舒芬太尼组相比，艾司氯胺酮组的镇静诱导时间更短，血流动力学更稳定（P < 0.05）。此外，两组在麻醉后恢复室（PACU）恶心或呕吐的发生率方面存在显著差异（P < 0.05），而次日并发症无统计学差异。
艾司氯胺酮联合丙泊酚用于EUS镇静可降低呼吸抑制，减少丙泊酚用量和术后恶心呕吐（PONV）的发生，并提供更稳定的血流动力学状态。因此，艾司氯胺酮可被视为EUS镇静时舒芬太尼的潜在替代药物。
