Background: Hypovolemia is common in colonoscopy due to fasting and bowel preparation, and propofol itself can reduce systemic vascular resistance, resulting in relative hypovolemia. Therefore, hypotension is not a rare event during propofol-based sedation for colonoscopy.
Objectives: Our objective was to explore the efficacy of esketamine as a sedative adjuvant in reducing the incidence of hypotension during colonoscopy.
Design: This was a prospective randomized trial. The trial was registered with the Chinese Clinical Trial Registry (ID: ChiCTR 2100047032).
Methods: We included 100 eligible patients who planned to receive a colonoscopy and randomly divided them into 4 groups with 25 patients in each group, which were propofol 2 mg/kg (Group P), propofol 1 mg/kg with esketamine 0.2 mg/kg (Group E1), propofol 1 mg/kg with esketamine 0.3 mg/kg (Group E2), and propofol 1 mg/kg with esketamine 0.4 mg/kg (Group E3). The hemodynamic and respiratory parameters were documented at various times during the procedure, including the patient's entry into the endoscopic room (T0), the induction of sedation (T1), the insertion of the colonoscope (T2), the removal of the colonoscope (T3), and the awakening of the patient (T4). The primary outcome was the incidence of hypotension. Secondary outcomes were cardiovascular side effects other than hypotension, incidence of hypoxia, cumulative changes in cardiovascular and respiratory parameters, total propofol dosage, anesthesia recovery time, and satisfactory levels of both patients and endoscopists.
Results: The incidence of hypotension in Group E1 (16%), Group E2 (16%), and Group E3 (12%) was significantly lower than in Group P (60%), with p values 0.003, 0.003, and <0.001 respectively. The cumulative changes in diastolic blood pressure and mean arterial pressure in Groups E1, E2, and E3 were significantly higher than in Group P (p = 0.024, p < 0.001, p = 0.006, respectively). Cumulative changes in systolic blood pressure in Group E3 were significantly higher than those in Group P (p = 0.012). The respiratory-related parameters were not statistically significant.
Conclusions: This study showed that the application of 0.4 mg/kg esketamine in propofol-based sedation reduced the incidence of hypotension during colonoscopy while providing satisfactory sedation.
Keywords: colonoscopy; esketamine; hypotension; propofol; sedation.
Impact of different doses of esketamine on incidence of hypotension in propofol-based sedation for colonoscopy.
Background: When people undergo colonoscopy and are sedated with propofol, about one-third of them experience low blood pressure. This study aims to see if adding esketamine to the propofol can help prevent or lessen these episodes of low blood pressure during colonoscopy.
Methods: This study examined four groups who received different doses of esketamine along with propofol. It focuses on differences in the occurrence of low blood pressure, respiratory measures, the amount of anesthetic used, and levels of satisfaction. The study analyzed the relevant data for these parameters to understand the differences between the groups.
Results: The results indicated that using esketamine along with propofol for sedation during colonoscopy led to several key outcomes, such as:• Three different concentrations of esketamine effectively reduced the occurrence of low blood pressure in patients undergoing colonoscopy.• Less propofol was needed in the groups that included esketamine.• Esketamine at a dosage of 0.4 mg kg-1 showed the best respiratory parameters among the four groups.
Conclusions: During colonoscopy, using esketamine along with propofol for sedation not only achieves satisfactory sedation but also lowers the occurrence of hypotension. Specifically, employing 0.4 mg kg-1 esketamine along with propofol not only reduces hypotension occurrences but also enhances respiration.
© The Author(s), 2024.