Discussion
delirium, desaturation, hallucinations, dizziness, headache, hypotension, nausea,, respiratory depression
ADVERSE EFFECTS, RESPIRATORY DEPRESSION, EVENTS
This multicenter randomized clinical trial found significant benefits of administering low-dose esketamine as an adjuvant to propofol-based sedation for patients undergoing same-visit bidirectional endoscopy. The addition of esketamine reduced the composite and separate outcomes of desaturation and hypotension during the procedures. Moreover, esketamine administration decreased propofol requirements without increasing associated adverse effects. To our knowledge, this is the first multicenter randomized clinical trial to establish the advantages of using low-dose esketamine in combination with propofol sedation for same-visit bidirectional endoscopic procedures.During propofol sedation, hemodynamic and respiratory depression is a common concern. In previous studies involving patients undergoing gastrointestinal endoscopy with propofol sedation, the incidence rates of desaturation and hypotension events were approximately 30%.Previous studies have investigated the use of low-dose esketamine as an adjunct to propofol for sedation during endoscopic procedures. Eberl et alIn contrast, our study results are based on a robust multicenter, randomized design, providing substantial clinical evidence supporting the administration of esketamine in combination with propofol sedation for endoscopic procedures. In our patient cohort, adding low-dose esketamine (0.15 mg/kg) to propofol-based sedation significantly reduced desaturation and hypotension events by 61% (an absolute reduction of 12.8 percentage points). Furthermore, the total propofol consumption was notably reduced by 30% (an absolute reduction of 58.9 mg). These beneficial treatment effects of esketamine remained significant even after adjusting for possible confounding covariates. Notably, low-dose esketamine demonstrated a favorable safety profile because it did not increase adverse effects, such as dizziness, headache, nausea, vomiting, nightmares, hallucinations, dissociation, emergence delirium, or illusions.