Cuicui Liu,1,* Yanting Wang,1,* Yanwei Yin,2 Pei Wang,1 Xiangyu Ji,1 Jian Sun,1 Shuo Zhao,1 Yanfang Jia,1 Shanling Liu,1 Zangong Zhou1 

1Daytime Anesthesiology Department, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China; 2Pain Department, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zangong Zhou, Daytime Anesthesiology Department, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, 266000, People’s Republic of China, Tel +86 532-82912511, Email zhouzangong@qdu.edu.cn

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

Keywords: esketamine, sedation, endoscopic ultrasound, respiratory depression