Effect of esketamine on the ED50 of propofol for successful insertion of ureteroscope in elderly male patients: a randomized controlled trial.
Xin Luo, Wen-Wen Hao, Xue Zhang, Yu-Xuan Qi, Li-Xin An
BMC Anesthesiology May 31, 2024 DOI: 10.1186/s12871-024-02580-z (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 49 |
| Population | Elderly male patients undergoing elective rigid ureteroscopy |
| Interventions | Esketamine Sufentanil Propofol |
| Dose | 0.25 mg/kg esketamine; 0.1 µg/kg sufentanil; propofol initial bolus 1.5 mg/kg then adjusted by 0.1 mg/kg |
| Topics | Esketamine |
| Keywords | Ed50 Elderly patients Propofol Ureteroscope Anesthesia Geriatric medicine Urology Drug combinations Patient safety |
| Citations | 7 |
| Key findings | Esketamine plus propofol reduced the median effective dose of propofol for successful ureteroscope insertion in elderly male patients compared with sufentanil plus propofol (1.356 vs. 1.442 mg/kg). |
Abstract
Propofol is effective and used as a kind of routine anesthetics in procedure sedative anesthesia (PSA) for ureteroscopy. However, respiratory depression and unconscious physical activity always occur during propofol-based PSA, especially in elderly patients. Esketamine has sedative and analgesic effects but without risk of cardiorespiratory depression. The purpose of this study is to investigate whether esketamine can reduce the propofol median effective dose (ED50) for successful ureteroscope insertion in elderly male patients. 49 elderly male patients undergoing elective rigid ureteroscopy were randomly divided into two groups: SK Group (0.25 mg/kg esketamine+propofol) and SF Group (0.1 µg/kg sufentanil+propofol). Patients in both two groups received propofol with initial bolus dose of 1.5 mg/kg after sufentanil or esketamine was administered intravenously. The effective dose of propofol was assessed by a modified Dixon's up-and-down method and then was adjusted with 0.1 mg/kg according to the previous patient response. Patients' response to ureteroscope insertion was classified as "movement" or "no movement". The primary outcome was the ED50 of propofol for successful ureteroscope insertion with esketamine or sufentanil. The secondary outcomes were the induction time, adverse events such as hemodynamic changes, hypoxemia and body movement were also measured. 49 patients were enrolled and completed this study. The ED50 of propofol for successful ureteroscope insertion in SK Group was 1.356 ± 0.11 mg/kg, which was decreased compared with that in SF Group, 1.442 ± 0.08 mg/kg (P = 0.003). The induction time in SK Group was significantly shorter than in SF Group (P = 0.001). In SK Group, more stable hemodynamic variables were observed than in SF Group. The incidence of AEs between the two groups was not significantly different. The ED50 of propofol with esketamine administration for ureteroscope insertion in elderly male patients is 1.356 ± 0.11 mg/kg, significantly decreased in comparsion with sufentanil. Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .
Comparable studies
Other randomized controlled trials on esketamine, most cited first.