Comparative Efficacy of Esketamine vs Sufentanil with Propofol for Sedation in EUS: A Randomized, Controlled Study.

Abstract

<h4>Purpose</h4>This randomized, controlled trial aimed to assess the sedative effects of esketamine and sufentanil combined with propofol during EUS.<h4>Patients and methods</h4>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 SPO₂ during the operation, and management of airway obstruction. In addition, other procedures and anesthesia-related outcomes, and postoperative complications were recorded.<h4>Results</h4>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 (<i>P</i> = 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 (<i>P</i> < 0.05). In addition, the lowest SPO₂ during the operation, occurrence rate of airway intervention, and management of airway obstruction were significantly different (<i>P</i> < 0.05). Compared to the sufentanil group, the induction time of sedation in the esketamine group was shorter, and the hemodynamics were more stable (<i>P</i> < 0.05). In addition, there were significant differences in the PACU incidence rates of nausea or vomiting between the two groups (<i>P</i> < 0.05), whereas the following day's complications showed no statistical difference.<h4>Conclusion</h4>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.

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