Background
nausea, anxiety, hypoxia, intracardiac right-to-left shunting, allergy, vomiting, pain, cyanotic CHD
ADVERSE REACTIONS, SEPARATION, HYPOXIA, ALLERGY
Preoperative pediatric anxiety occurs in approximately 50–60% of children, especially those aged 1–5 years. This may have a negative psychological impact on children undergoing surgery [Preoperative sedation can alleviate perioperative anxiety of young children, thus creating a good condition for parental separation and anesthesia induction [Intranasal premedication is simple and minimally invasive compared with intramuscular or intravenous injections. Absorption is more complete, avoiding first-pass metabolism, and provides anesthesiologists with an alternative route for preoperative sedation. Midazolam, dexmedetomidine, and ketamine are sedatives for preoperative sedation in children, among which dexmedetomidine is more commonly used. However, dexmedetomidine will likely slow the heart rate [Esketamine is also effective for pain relief because of ease of use and minimal effect on respiration. In addition, it has the feature of sympathetic activity, can increase systemic vascular resistance, and reduce intracardiac right-to-left shunting in children with cyanotic CHD, thus relieving hypoxia.To the best of our knowledge, there is a lack of research on the median effective dose (EDOur pilot experiments suggested that a dose of 0.5–1.5 mg/kg could achieve an expected sedative effect in most children, and no evident inhibition of breathing and circulation was observed. Adverse reactions such as allergy, nausea, and vomiting have not been recorded. At present, the dosage of esketamine has not been clearly determined. To rationally apply esketamine to clinical practice, we designed this experiment to determine the ED