Efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy: a prospective, randomized, double-blind controlled clinical trial.

Background: We explored the efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy.

Methods: A total of 195 patients who underwent painless colonoscopy surgery were randomly divided into three groups: the propofol deep sedation group (group DS), the sufentanil combined with propofol for conscious sedation (group CS₁) and the esketamine combined with propofol for conscious sedation (group CS₂). The primary outcomes of this study included the incidence of hypoxemia, hypotension, hypertension, and bradycardia and excellent and good rates of anaesthesia during colonoscopy. The secondary outcomes included perioperative changes in vital signs (MAP, HR, and SpO₂), anaesthesia induction time, dischargeable time, patient and endoscopist satisfaction scores, and incidence of postoperative nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, assisted ventilation and vasoactive medications.

Results: The incidence of intraoperative hypoxemia in the DS group was significantly greater than that in the CS₁ and CS₂ groups (χ2 = 7.081, P = 0.029). The incidence of hypotension in the CS₂ group was significantly lower than that in the DS and CS₁ groups (χ2 = 16.278, P < 0.001). The risk of hypoxemia was 5.727 times higher in Group DS than in Group CS₂ (OR 5.727; 95%CI 1.203-27.273), and the risk of hypotension was 9.864 times higher in Group DS than in Group CS₂ (OR 9.864; 95%CI 2.770-35.120). The risk of hypotension in Group CS₁ was 5.167 times that in Group CS₂ (OR 5.167; 95%CI 1.396-19.117). The incidence of propofol injection pain, assisted ventilation, ephedrine usage and drowsiness in the DS group was significantly greater than that in the CS₁ and CS₂ groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery in the CS₁ group was significantly greater than that in the DS and CS₂ groups (χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was significantly greater than that in the CS₁ and CS₂ groups (F = 53.039, P < 0.001). The satisfaction scores of the endoscopist and patients in the DS group were significantly lower than those in the CS₁ and CS₂ groups (F = 17.390, P < 0.001; F = 19.282; P < 0.001).

Conclusions: In conclusion, esketamine combined with propofol for conscious sedation can be safely and effectively used for painless colonoscopy and has fewer complications.It is recommended for painless colonoscopy.