Safety and efficacy of Esketamine Hydrochloride combined with Propofol in painless colorectal sedation in obese patients
YE Zong1 HE Yapeng1 XIANG Jun2 MOU Junying2 CUI Zhihong2 ZHANG Jie2 ZHU Xianlin2
1.Graduate College, Hubei University of Medicine, Hubei Province, Shiyan 442000, China;
2.Department of Anesthesiology, the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province, Enshi 445000, China
Abstract：Objective To observe the safety and efficacy of Esketamine Hydrochloride combined with Propofol for obese patients undergoing painless colorectal endoscopy sedation. Methods A total of 88 obese patients who underwent painless colorectal endoscopy sedation in Outpatient Clinic of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province from March to October 2022 were included. They were divided into Esketamine group and control group using random number table and envelope allocation concealment method, with 44 cases in each group. Induction programme: Esketamine Hydrochloride (0.2 mg/kg)+Propofol (1-2 mg/kg) was injected intravenously in Esketamine group, and Sufentanil (0.1 μg/kg)+Propofol (1-2 mg/kg) was injected intravenously in control group; intraoperative anesthesia maintenance drugs: Propofol [3-4 mg/(kg·h)] was pumped intravenously. The drug was stopped five minutes before the end of the operation in both groups, and the patients were sent to the resuscitation room for observation after the examination. Effectiveness of sedation, anesthesia awakening time, time to discharge criteria, Propofol dosage, and visual analog scale (VAS) score at discharge between two groups were compared; heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), modified observer’s assessment of alert/sedation (MOAA/S) scores between two groups were compared after entering the room (T0), after completion of anesthesia induction (T1), enteroscopy into the anus (T2), enteroscopy to the ileocecal region (T3), end of colonoscopy withdrawal (T4), and five minutes after the end of examination (T5); intubation tolerance scores between two groups were compared at T2-T4; the incidence of complications between two groups were recorded. Results There were no significant differences in effectiveness of sedation, anesthesia awakening time, and VAS score at discharge between two groups (P＞0.05). The time to discharge criteria in Esketamine group was shorter than that in control group, the Propofol dosage was smaller than that in control group, and the differences were statistically significant (P＜0.05). At T0-T5, HR and MAP in two groups at different time points were compared, and the differences were statistically significant (P＜0.05). At T2, SpO2 was lower than that at T1, and the difference was statistically significant (P＜0.05); at T3, SpO2 in two groups were higher than those at T2, and the differences were statistically significant (P＜0.05); at T4, SpO2 in two groups were higher than those at T2-T3, and the differences were statistically significant (P＜0.05); At T5, SpO2 in Esketamine group was higher than that at T3, and the difference were statistically significant (P＜0.05). At T1-T4, HR of Esketamine group was higher than that of control group, and the difference was statistically significant (P＜0.05); at T1-T5, MAP of Esketamine group was higher than of control group, and the difference was statistically significant (P＜0.05); at T1-T3, SpO2 in Esketamine group was higher than that in control group, and the difference was statistically significant (P＜0.05). At T5, MOAA/S score in Esketamine group was lower than that at T0, and higher than that at T4, and the differences were statistically significant (P＜0.05). At T4, MOAA/S score in control group was higher than that at T1, and the difference was statistically significant (P＜0.05); at T5, MOAA/S score in control group was higher than that at T4, and the difference was statistically significant (P＜0.05). At T4, MOAA/S score of Esketamine group was higher than that of control group, and the difference was statistically significant (P＜0.05). No diplopia, hallucination, or postoperative agitation occurred in two groups. The incidence of respiratory depression and hypotension in Esketamine group was lower than that in control group, and the difference was statistically significant (P＜0.05); there was no significant difference in the incidence of bradycardia, tachycardia, dizziness, nausea, vomiting, and choking between two groups (P＞0.05). Conclusion Esketamine Hydrochloride combined with Propofol has high safety and efficacy for obese patients undergoing painless colorectal endoscopy sedation.
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