ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606134
Safety and efficacy evaluation of low-dose of esketamine combined with propofol for painless gastroscopy: a single-center, randomized, double-blind, parallel controlled clinical trial
Provisionally accepted
- Second Affiliated Hospital of Shantou University Medical College, Shantou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Propofol combined with sufentanil is the most commonly used anesthesia regimen for painless gastroscopy in China. However, this combination carries a higher risk of circulatory and respiratory depression. Esketamine, with its strong analgesic and sympathetic excitatory effects, may be a safer alternative. This study aimed to evaluate the safety and efficacy of propofol-sufentanil versus propofol-esketamine for painless gastroscopy in adults. Methods: 120 participants were randomly assigned to four groups: PS (propofol 2mg/kg + sufentanil 0.1μg/kg), PE1 (propofol 2mg/kg + esketamine 0.05mg/kg), PE2 (propofol 2mg/kg + esketamine 0.1mg/kg), and PE3 (propofol 2mg/kg + esketamine 0.2mg/kg). The primary outcome was the incidence of reflex cough during gastroscopy insertion. Secondary outcomes included hemodynamic changes, pulse oxygen saturation, induction time, recovery time, discharge time, propofol consumption, and the occurrence of adverse events. Results: There was no significant difference in reflex cough, body movement response, or propofol injection pain between the PS, PE2, and PE3 groups, but these incidences were significantly lower than in the PE1 group (P<0.05). Hypotension occurred less frequently in PE2 and PE3 compared to PS and PE1 (P=0.001), with more stable hemodynamics observed in PE2 and PE3. However, the incidence of tachycardia was significantly higher in the PE3 group than in the others (P<0.05). Fewer participants in PE3 and PS required additional propofol compared to PE1 (P<0.05), with no significant difference between PS, PE2, and PE3 (P>0.05). Induction time was significantly shorter in PE3 compared to PS and PE1, with no difference between PE3 and PE2 (P>0.05). However, recovery time was longest in PE3 (P=0.002). No significant differences were found in other outcomes (P>0.05). Conclusion: Considering the superior safety and efficacy observed in the PE2 group, we recommend the combination of 2 mg/kg propofol and 0.1 mg/kg esketamine as the optimal anesthesia for painless gastroscopy. This combination provides several benefits, including reduced reflex cough, stable hemodynamics, and faster recovery, making it a valuable clinical practice.
Keywords: Esketamine, Propofol, Painless gastroscopy, reflex cough, Safety
Received: 08 Apr 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Gu, Zhuang, Wu, Huang, Lin and Z'hang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yong-Fa Z'hang, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.