Median effective dose (ED50) of esketamine combined with different doses of propofol for children to inhibit the response to gastroscope insertion: a prospective dose–response clinical study

This study aimed to evaluate whether combining esketamine with different doses of propofol could reduce drug requirements and minimize adverse effects in children undergoing gastroscopy. Eighty-eight children scheduled for painless gastroscopy were randomly assigned to four groups receiving propofol at doses of 1, 2, 3, or 4 mg/kg. Esketamine was administered using the Dixon up-and-down sequential method. Failure was defined as coughing, gagging, or airway obstruction during initial gastroscope insertion. The median effective dose (ED50) and 95% confidence intervals were calculated using the up-and-down method and probit regression analysis. The ED50 of esketamine decreased significantly with increasing doses of propofol. The ED50 of esketamine combined with propofol 4 mg/kg was significantly lower than that observed with propofol doses of 1, 2, and 3 mg/kg (P < 0.001), and the ED50 with propofol 3 mg/kg was significantly lower than that with propofol 1 and 2 mg/kg (P < 0.05). Recovery time was significantly longer in the propofol 2, 3, and 4 mg/kg groups compared with the 1 mg/kg group, and the incidence of hypotension was higher in the propofol 4 mg/kg group. During recovery, children receiving propofol 1 mg/kg experienced a higher incidence of delirium and visual disturbances. No significant differences were observed in examination time, physician satisfaction, or respiratory depression among the groups. Combining esketamine with propofol reduced the esketamine dose required for pediatric gastroscopy in a propofol dose-dependent manner. Among the regimens studied, esketamine combined with 2 mg/kg propofol appears to provide a more favorable balance between anesthetic efficacy and safety.