Research progress on the application of esketamine in endoscopic diagnosis and treatment_West China Medical Journal

Authors：

XIAO Lizhu ¹ ,  ZOU Xiaohua ²

1. Department of Anesthesiology, the First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan 418000, P. R. China;
2. Department of Anesthesiology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550000, P. R. China;

Corresponding?author：

ZOU Xiaohua, Email: 562931613@qq.com

Keywords：

Esketamine; endoscopy; sedation and analgesia; clinical effect

DOI：

10.7507/1002-0179.202304137

Video：

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Abstract Full text Figures/Tables Video References Cited by

Sedation and analgesia techniques are widely used in endoscopic diagnosis and treatment. The main purpose is to relieve the anxiety and pain of patients and reduce the risk of complications. Esketamine has obvious advantages in the clinical application of sedative and analgesic endoscopy. For example, it has strong sedative and analgesic efficacy, slight influence on respiratory circulation with its sympathomimetic properties, rapid recovery, improved postoperative cognitive function, and fewer adverse reactions. However, due to the dose-dependent side effects of esketamine, it is necessary to pay attention to adverse reactions such as increased drainage, psychotropic symptoms, nausea and vomiting, and vertigo. This article summarizes the clinical effect of esketamine, the selection of drug dosage and the research progress of clinical application in special population during diagnosis and treatment of digestive endoscopy, respiratory endoscopy and gynecological endoscopy, in order to provide a reference for clinical research and drug guidance.

Citation： XIAO Lizhu, ZOU Xiaohua. Research progress on the application of esketamine in endoscopic diagnosis and treatment. West China Medical Journal, 2023, 38(9): 1423-1427. doi: 10.7507/1002-0179.202304137 Copy

1.	Molero P, Ramos-Quiroga JA, Martin-Santos R, et al. Antidepressant efficacy and tolerability of ketamine and esketamine: a critical review. CNS Drugs, 2018, 32(5): 411-420.
2.	Jonkman K, Duma A, Olofsen E, et al. Pharmacokinetics and bioavailability of inhaled esketamine in healthy volunteers. Anesthesiology, 2017, 127(4): 675-683.
3.	Zhang C, He J, Shi Q, et al. Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial. BMC Anesthesiol, 2022, 22(1): 138.
4.	Feng M, Shi G, Cui W, et al. The median effective concentration of propofol in combination with different doses of esketamine during gastrointestinal endoscopy in adults. Front Pharmacol, 2022, 13: 1034236.
5.	Wang J, Huang J, Yang S, et al. Pharmacokinetics and safety of esketamine in chinese patients undergoing painless gastroscopy in comparison with ketamine: a randomized, open-label clinical study. Drug Des Devel Ther, 2019, 13: 4135-4144.
6.	Wang X, Lin C, Lan L, et al. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis. J Clin Anesth, 2021, 68: 110071.
7.	Xin N, Yan W, Jin S. Efficacy of analgesic propofol/esketamine and propofol/fentanyl for painless induced abortion: a randomized clinical trial. Biomed Res Int, 2022, 2022: 5095282.
8.	康焱茗, 王曉. 最適鎮靜/麻醉深度在消化內鏡無痛技術中的價值和實施. 華西醫學, 2017, 32(6): 949-953.
9.	Zhou S, Zhu Z, Dai W, et al. National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth, 2021, 127(1): 56-64.
10.	Song N, Shan XS, Yang Y, et al. Low-dose esketamine as an adjuvant to propofol sedation for same-visit bidirectional endoscopy: protocol for a multicenter randomized controlled trial. Int J Gen Med, 2022, 15: 4733-4740.
11.	Long YQ, Feng CD, Ding YY, et al. Esketamine as an adjuvant to ciprofol or propofol sedation for same-day bidirectional endoscopy: protocol for a randomized, double-blind, controlled trial with factorial design. Front Pharmacol, 2022, 13: 821691.
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14.	Yi X, Xu W, Li A. The clinical application of remimazolam benzenesulfonate combined with esketamine intravenous anesthesia in endoscopic retrograde cholangiopancreatography. Biomed Res Int, 2022, 2022: 5628687.
15.	Zhan Y, Liang S, Yang Z, et al. Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial. BMC Gastroenterol, 2022, 22(1): 391.
16.	Lian X, Lin Y, Luo T, et al. Efficacy and safety of esketamine for sedation among patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. BMC Anesthesiol, 2023, 23(1): 204.
17.	Dahan A, Olofsen E, Sigtermans M, et al. Population pharmacokinetic-pharmacodynamic modeling of ketamine-induced pain relief of chronic pain. Eur J Pain, 2011, 15(3): 258-267.
18.	鄧麗珍, 尹泉, 曾偉, 等. 復合丙泊酚時艾司氯胺酮抑制不同年齡患者胃鏡置入反應的有效劑量. 中國新藥與臨床雜志, 2023: 1-9.
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41.	Ozturk T, Ac?kel A, Y?lmaz O, et al. Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial. J Clin Anesth, 2016, 35: 90-95.
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1. Molero P, Ramos-Quiroga JA, Martin-Santos R, et al. Antidepressant efficacy and tolerability of ketamine and esketamine: a critical review. CNS Drugs, 2018, 32(5): 411-420.
2. Jonkman K, Duma A, Olofsen E, et al. Pharmacokinetics and bioavailability of inhaled esketamine in healthy volunteers. Anesthesiology, 2017, 127(4): 675-683.
3. Zhang C, He J, Shi Q, et al. Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial. BMC Anesthesiol, 2022, 22(1): 138.
4. Feng M, Shi G, Cui W, et al. The median effective concentration of propofol in combination with different doses of esketamine during gastrointestinal endoscopy in adults. Front Pharmacol, 2022, 13: 1034236.
5. Wang J, Huang J, Yang S, et al. Pharmacokinetics and safety of esketamine in chinese patients undergoing painless gastroscopy in comparison with ketamine: a randomized, open-label clinical study. Drug Des Devel Ther, 2019, 13: 4135-4144.
6. Wang X, Lin C, Lan L, et al. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis. J Clin Anesth, 2021, 68: 110071.
7. Xin N, Yan W, Jin S. Efficacy of analgesic propofol/esketamine and propofol/fentanyl for painless induced abortion: a randomized clinical trial. Biomed Res Int, 2022, 2022: 5095282.
8. 康焱茗, 王曉. 最適鎮靜/麻醉深度在消化內鏡無痛技術中的價值和實施. 華西醫學, 2017, 32(6): 949-953.
9. Zhou S, Zhu Z, Dai W, et al. National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals. Br J Anaesth, 2021, 127(1): 56-64.
10. Song N, Shan XS, Yang Y, et al. Low-dose esketamine as an adjuvant to propofol sedation for same-visit bidirectional endoscopy: protocol for a multicenter randomized controlled trial. Int J Gen Med, 2022, 15: 4733-4740.
11. Long YQ, Feng CD, Ding YY, et al. Esketamine as an adjuvant to ciprofol or propofol sedation for same-day bidirectional endoscopy: protocol for a randomized, double-blind, controlled trial with factorial design. Front Pharmacol, 2022, 13: 821691.
12. Eberl S, Koers L, van Hooft J, et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: a randomised controlled multicentre trial. Eur J Anaesthesiol, 2020, 37(5): 394-401.
13. Eberl S, Koers L, van Hooft JE, et al. Sedation with propofol during ERCP: is the combination with esketamine more effective and safer than with alfentanil? Study protocol for a randomized controlled trial. Trials, 2017, 18(1): 472.
14. Yi X, Xu W, Li A. The clinical application of remimazolam benzenesulfonate combined with esketamine intravenous anesthesia in endoscopic retrograde cholangiopancreatography. Biomed Res Int, 2022, 2022: 5628687.
15. Zhan Y, Liang S, Yang Z, et al. Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial. BMC Gastroenterol, 2022, 22(1): 391.
16. Lian X, Lin Y, Luo T, et al. Efficacy and safety of esketamine for sedation among patients undergoing gastrointestinal endoscopy: a systematic review and meta-analysis. BMC Anesthesiol, 2023, 23(1): 204.
17. Dahan A, Olofsen E, Sigtermans M, et al. Population pharmacokinetic-pharmacodynamic modeling of ketamine-induced pain relief of chronic pain. Eur J Pain, 2011, 15(3): 258-267.
18. 鄧麗珍, 尹泉, 曾偉, 等. 復合丙泊酚時艾司氯胺酮抑制不同年齡患者胃鏡置入反應的有效劑量. 中國新藥與臨床雜志, 2023: 1-9.
19. 萬幸, 楊青青, 樊迪, 等. 亞麻醉劑量艾司氯胺酮復合丙泊酚應用于無痛胃腸鏡檢查的效果. 臨床麻醉學雜志, 2022, 38(2): 144-148.
20. 盛奎, 胡憲文, 吳云, 等. 低劑量艾司氯胺酮聯合丙泊酚在無痛胃腸鏡檢查中的臨床研究. 中國醫刊, 2022, 57(3): 341-344.
21. 張忠其, 許亞菲, 張艷靜, 等. 丙泊酚復合小劑量艾司氯胺酮抑制胃鏡置入反應的有效劑量. 臨床麻醉學雜志, 2021, 37(9): 949-952.
22. 王立紅, 楊彥偉, 彭曉風, 等. 不同劑量艾司氯胺酮復合丙泊酚用于胃腸鏡檢查的麻醉效果. 中國新藥與臨床雜志, 2023, 42(7): 451-456.
23. Yin S, Hong J, Sha T, et al. Efficacy and tolerability of sufentanil, dexmedetomidine, or ketamine added to propofol-based sedation for gastrointestinal endoscopy in elderly patients: a prospective, randomized, controlled trial. Clin Ther, 2019, 41(9): 1864-1877.e0.
24. 宋兆卿, 李冬冬. 小劑量艾司氯胺酮在老年患者無痛胃腸鏡診療中的應用. 濰坊醫學院學報, 2021, 43(6): 475-477.
25. Flint RB, Brouwer CNM, Kr?nzlin ASC, et al. Pharmacokinetics of S-ketamine during prolonged sedation at the pediatric intensive care unit. Paediatr Anaesth, 2017, 27(11): 1098-1107.
26. 田迪, 邱永升, 賈英萍. 艾司氯胺酮與納布啡在小兒無痛胃鏡中的應用效果. 河南醫學研究, 2022, 31(20): 3736-3739.
27. Zheng X, Huang J, Wei S, et al. Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial. Front Pediatr, 2023, 11: 1126522.
28. Chen HY, Meng XY, Gao H, et al. Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a randomized, double-blinded, multicentre trial. Trials, 2023, 24(1): 13.
29. Saran JS, Kreso M, Khurana S, et al. Anesthetic considerations for patients undergoing bronchial thermoplasty. Anesth Analg, 2018, 126(5): 1575-1579.
30. Esmailian M, Koushkian Esfahani M, et al. The effect of low-dose ketamine in treating acute asthma attack; a randomized clinical trial. Emerg (Tehran), 2018, 6(1): e21.
31. 楊春, 劉寒玉, 劉存明. 艾司氯胺酮的臨床應用進展. 臨床麻醉學雜志, 2023, 39(4): 414-417.
32. Huang X, Ai P, Wei C, et al. Comparison of the effects of esketamine/propofol and sufentanil/propofol on the incidence of intraoperative hypoxemia during bronchoscopy: protocol for a randomized, prospective, parallel-group trial. J Clin Med, 2022, 11(15): 4587.
33. Nie J, Chen W, Jia Y, et al. Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy. BMC Pulm Med, 2023, 23(1): 254.
34. Feng Y, Du T, Wang J, et al. Low dose of esketamine combined with propofol in painless fibronchoscopy in elderly patients. Medicine (Baltimore), 2022, 101(50): e31572.
35. 郭玲玲, 何文勝, 陳亮, 等. 艾司氯胺酮對無痛纖維支氣管鏡檢查患者術后早期恢復質量的影響. 實用臨床醫藥雜志, 2022, 26(6): 90-94.
36. 張影. 觀察艾司氯胺酮聯合丙泊酚用于無痛支氣管鏡檢查麻醉的安全性及有效性. 外科研究與新技術, 2022, 11(3): 179-182.
37. 季瑩瑩, 姜靜, 侯慧艷, 等. 艾司氯胺酮聯合右美托咪定用于小兒纖支鏡檢查安全性研究. 兒科藥學雜志, 2023, 29(3): 32-35.
38. 王璐, 張瑞冬, 張鶯, 等. 右美托咪定聯合固定劑量艾司氯胺酮誘導兒童睡眠氣道鏡檢查的藥物半數有效劑量探討. 上海醫學, 2022, 45(3): 171-174.
39. Tu W, Yuan H, Zhang S, et al. Influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition of elderly surgical patients. Am J Transl Res, 2021, 13(3): 1701-1709.
40. 姬麗婷, 鄭群燕, 楊淑芬, 等. 小劑量艾司氯胺酮對老年無痛纖維支氣管鏡檢查的麻醉效果和早期認知功能的影響. 全科醫學臨床與教育, 2023, 21(7): 615-618.
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