Adjuvant esketamine reduces desaturation, hypotension during bidirectional endoscopy
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Key takeaways:
- Low-dose esketamine reduced incidence of composite desaturation and hypotension compared with saline (8.2% vs. 21%).
- Propofol requirements also were reduced with esketamine administration (difference, –58.9 mg).
The incorporation of low-dose esketamine to propofol-based sedation reduced desaturation and hypotension events by approximately 61% among patients undergoing same-visit bidirectional endoscopy, researchers reported.
“Many patients now undergo esophagogastroduodenoscopy and colonoscopy during the same hospital visit, commonly known as same-visit bidirectional endoscopy,” Nan Song, MD, of the department of anesthesiology at The First Affiliated Hospital of Soochow University, and colleagues wrote in JAMA Network Open. “Although propofol, either alone or in combination with analgesics, is the standard sedation choice for endoscopic procedures, it is not without its drawbacks, as adverse events, such as desaturation and hypotension, have been reported.”
They continued: “One promising alternative is esketamine, an N-methyl-D-aspartate receptor antagonist and the dextrorotatory isomer of ketamine.”
In a multicenter, double-blind, randomized controlled trial, researchers investigated the effect of low-dose esketamine combined with propofol among 660 patients (median age, 48 years; 53.8% women) who underwent bidirectional endoscopy from February to November 2022. All patients underwent induction with 0.1 µg/kg of sufentanil and 0.5 mg/kg of propofol, followed by either 0.15 mg/kg of IV esketamine (n = 331) or saline at an equivalent volume (n = 329).
The primary studied outcome was the composite of desaturation and hypotension during the procedures, while secondary outcomes included individual desaturation and hypotension events, propofol requirements, post-procedure pain and fatigue, nausea or vomiting, dizziness or headache, hallucination or nightmare, and endoscopist and patient satisfaction.
Compared with saline, administration of low-dose esketamine significantly reduced the composite outcome of desaturation and hypotension (8.2% vs. 21%; risk difference = –12.8 percentage points; OR = 0.34; 95% CI, 0.21-0.54). In addition, individual rates of desaturation (3.6% vs. 9.4%; OR = 0.36; 95% CI, 0.18-0.72) and hypotension (4.8% vs. 13.4%; OR = 0.33; 95% CI, 0.18-0.6) were lower with the use of esketamine, as were propofol requirements (difference = –58.9 mg; 95% CI, –65.7 to –52.2).
Researchers reported no significant differences between groups for the other secondary outcomes.
“This multicenter, randomized clinical trial provides compelling evidence that the addition of low-dose esketamine to propofol-based sedation significantly reduces the incidence of composite desaturation and hypotension events during same-visit bidirectional endoscopy,” Song and colleagues wrote. “Moreover, the use of esketamine led to a noteworthy decrease in propofol requirements for these procedures while causing no safety concerns.”
They concluded: “On the basis of these findings, the incorporation of esketamine as an adjuvant to propofol sedation is strongly supported for patients undergoing same-visit bidirectional endoscopy.”
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