Esketamine, effective alternative for sedation in patients undergoing GI endoscopy

Gastroscopy and colonoscopy are popularly used in the diagnostics of gastrointestinal and colorectal diseases. The present clinical guidelines have recommended the application of anesthesia sedation to relieve the associated physical and emotional stress, which would improve the examination outcomes during the diagnosis.

Patients undergoing gastrointestinal endoscopy often require propofol-based sedation combined with analgesics. The efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients remains controversial, to assess the efficacy and safety of esketamine as an adjunct to propofol for sedation during endoscopic procedures in patients was conducted by team of researchers.

Xianghong Lian, and team found that Esketamine is an appropriate effective alternative for sedation in participants undergoing gastrointestinal endoscopy. The findings of the study are published in BMC Anesthesiology.

Researchers used seven electronic databases and three clinical trial registry platforms were searched and the deadline was February 2023. Randomized controlled trials (RCTs) evaluating the efficacy of esketamine for sedation were included by two reviewers. Data from the eligible studies were combined to calculate the pooled risk ratio or standardized mean difference.

The key findings of the study are

• A total of 18 studies with 1962 esketamine participants were included in the analysis. As an adjunct to propofol, the administration of esketamine reduced the recovery time compared to normal saline (NS).

• However, there was no significant difference between the opioids group and ketamine group. For propofol dosage, the administration of esketamine required a lower propofol dosage compared to the NS group and opioids group.

• For complications, the esketamine group had fewer complications compared to the NS group and opioid group in patients, but there were no significant differences between the esketamine group and ketamine group.

• Notably, the coadministration of esketamine was associated with a higher risk of visual disturbance compared to the NS group. In addition, we used subgroup analysis to investigate whether 0.2–0.5 mg/kg esketamine was effective and tolerable for patients.

Xianghong Lian, and team concluded that esketamine as an adjunct to propofol, is an appropriate effective alternative for sedation in participants undergoing gastrointestinal endoscopy. However, considering the possibility of its psychotomimetic effects, esketamine should be used with caution.

Reference: 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 23, 204 (2023). https://doi.org/10.1186/s12871-023-02167-0.