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, 王晓. 最适镇静/麻醉深度在消化内镜无痛技术中的价值和实施. 华西医学, 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.	邓丽珍, 尹泉, 曾伟, 等. 复合丙泊酚时艾司氯胺酮抑制不同年龄患者胃镜置入反应的有效剂量. 中国新药与临床杂志, 2023: 1-9.
19.	万幸, 杨青青, 樊迪, 等. 亚麻醉剂量艾司氯胺酮复合丙泊酚应用于无痛胃肠镜检查的效果. 临床麻醉学杂志, 2022, 38(2): 144-148.
20.	盛奎, 胡宪文, 吴云, 等. 低剂量艾司氯胺酮联合丙泊酚在无痛胃肠镜检查中的临床研究. 中国医刊, 2022, 57(3): 341-344.
21.	张忠其, 许亚菲, 张艳静, 等. 丙泊酚复合小剂量艾司氯胺酮抑制胃镜置入反应的有效剂量. 临床麻醉学杂志, 2021, 37(9): 949-952.
22.	王立红, 杨彦伟, 彭晓风, 等. 不同剂量艾司氯胺酮复合丙泊酚用于胃肠镜检查的麻醉效果. 中国新药与临床杂志, 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. 小剂量艾司氯胺酮在老年患者无痛胃肠镜诊疗中的应用. 潍坊医学院学报, 2021, 43(6): 475-477.
25.	Flint RB, Brouwer CNM, Kränzlin 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, 贾英萍. 艾司氯胺酮与纳布啡在小儿无痛胃镜中的应用效果. 河南医学研究, 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.	杨春, 刘寒玉, 刘存明. 艾司氯胺酮的临床应用进展. 临床麻醉学杂志, 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.
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37.	季莹莹, 姜静, 侯慧艳, 等. 艾司氯胺酮联合右美托咪定用于小儿纤支镜检查安全性研究. 儿科药学杂志, 2023, 29(3): 32-35.
38.	王璐, 张瑞冬, 张莺, 等. 右美托咪定联合固定剂量艾司氯胺酮诱导儿童睡眠气道镜检查的药物半数有效剂量探讨. 上海医学, 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.	姬丽婷, 郑群燕, 杨淑芬, 等. 小剂量艾司氯胺酮对老年无痛纤维支气管镜检查的麻醉效果和早期认知功能的影响. 全科医学临床与教育, 2023, 21(7): 615-618.
41.	Ozturk T, Acıkel A, Yılmaz 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.
42.	Binsaeedu AS, Prabakar D, Ashkar M, et al. Evaluating the safety and efficacy of ketamine as a bronchodilator in pediatric patients with acute asthma exacerbation: a review. Cureus, 2023, 15(6): e40789.
43.	La Via L, Sanfilippo F, Cuttone G, et al. Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies. Eur J Clin Pharmacol, 2022, 78(10): 1613-1622.
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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, 王晓. 最适镇静/麻醉深度在消化内镜无痛技术中的价值和实施. 华西医学, 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. 邓丽珍, 尹泉, 曾伟, 等. 复合丙泊酚时艾司氯胺酮抑制不同年龄患者胃镜置入反应的有效剂量. 中国新药与临床杂志, 2023: 1-9.
19. 万幸, 杨青青, 樊迪, 等. 亚麻醉剂量艾司氯胺酮复合丙泊酚应用于无痛胃肠镜检查的效果. 临床麻醉学杂志, 2022, 38(2): 144-148.
20. 盛奎, 胡宪文, 吴云, 等. 低剂量艾司氯胺酮联合丙泊酚在无痛胃肠镜检查中的临床研究. 中国医刊, 2022, 57(3): 341-344.
21. 张忠其, 许亚菲, 张艳静, 等. 丙泊酚复合小剂量艾司氯胺酮抑制胃镜置入反应的有效剂量. 临床麻醉学杂志, 2021, 37(9): 949-952.
22. 王立红, 杨彦伟, 彭晓风, 等. 不同剂量艾司氯胺酮复合丙泊酚用于胃肠镜检查的麻醉效果. 中国新药与临床杂志, 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. 小剂量艾司氯胺酮在老年患者无痛胃肠镜诊疗中的应用. 潍坊医学院学报, 2021, 43(6): 475-477.
25. Flint RB, Brouwer CNM, Kränzlin 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, 贾英萍. 艾司氯胺酮与纳布啡在小儿无痛胃镜中的应用效果. 河南医学研究, 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. 杨春, 刘寒玉, 刘存明. 艾司氯胺酮的临床应用进展. 临床麻醉学杂志, 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, 何文胜, 陈亮, 等. 艾司氯胺酮对无痛纤维支气管镜检查患者术后早期恢复质量的影响. 实用临床医药杂志, 2022, 26(6): 90-94.
36. 张影. 观察艾司氯胺酮联合丙泊酚用于无痛支气管镜检查麻醉的安全性及有效性. 外科研究与新技术, 2022, 11(3): 179-182.
37. 季莹莹, 姜静, 侯慧艳, 等. 艾司氯胺酮联合右美托咪定用于小儿纤支镜检查安全性研究. 儿科药学杂志, 2023, 29(3): 32-35.
38. 王璐, 张瑞冬, 张莺, 等. 右美托咪定联合固定剂量艾司氯胺酮诱导儿童睡眠气道镜检查的药物半数有效剂量探讨. 上海医学, 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. 姬丽婷, 郑群燕, 杨淑芬, 等. 小剂量艾司氯胺酮对老年无痛纤维支气管镜检查的麻醉效果和早期认知功能的影响. 全科医学临床与教育, 2023, 21(7): 615-618.
41. Ozturk T, Acıkel A, Yılmaz 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.
42. Binsaeedu AS, Prabakar D, Ashkar M, et al. Evaluating the safety and efficacy of ketamine as a bronchodilator in pediatric patients with acute asthma exacerbation: a review. Cureus, 2023, 15(6): e40789.
43. La Via L, Sanfilippo F, Cuttone G, et al. Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies. Eur J Clin Pharmacol, 2022, 78(10): 1613-1622.
44. 钱夏丽, 夏凡, 沈晓凤, 等. 艾司氯胺酮复合丙泊酚在宫腔镜检查术中的应用. 临床麻醉学杂志, 2021, 37(7): 706-708.
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