Seeing the Difference: Study evaluates Low-Dose Esketamine and Propofol in Pediatric Eye Surgery

Low-dose esketamine combined with propofol is being investigated for its effects on pediatric patients undergoing strabismus surgery, a procedure that requires careful anesthetic management due to the challenges of insufficient patient cooperation in a young demographic. Recently published randomized controlled trial aimed to mitigate propofol-induced injection pain (PIP) and enhance recovery quality by integrating esketamine, which is noted for its rapid onset and favorable pharmacokinetics compared to racemic ketamine. Eighty-four children aged 3-15 years were enrolled and randomized into two groups: one receiving low-dose esketamine (0.2 mg/kg) alongside propofol (2.5 mg/kg), and the other receiving saline and propofol. Key outcomes measured included the incidence of PIP, early postoperative recovery (using the Children's Pain Behavioral Scale), hemodynamic stability (heart rate and mean arterial pressure), and perioperative adverse events such as emergence agitation and oculocardiac reflex.

Results Summary

Results indicated a significant reduction in PIP in the esketamine group (56.1% incidence) compared to the control group (87.5%), with a consequent decrease in moderate-to-severe pain occurrences. Children in the esketamine group also exhibited lower pain scores in the immediate postoperative phase compared to the control group, although both groups reported similar pain levels by postoperative day 3 and 7, reflecting the short duration and low trauma of the surgical procedure. Hemodynamic parameters showed comparable stability between groups, although both demonstrated reductions post-induction. Importantly, the incidence of emergence agitation, oculocardiac reflex, and extubation cough were significantly lower in the esketamine group, suggesting improved overall anesthetic quality and patient comfort during the emergence phase.

Study Limitations

Despite these encouraging findings, the study acknowledges limitations, such as its small sample size and single-center nature, which may affect the generalizability of the results. Further, the lack of follow-up on long-term outcomes and quality of life highlights the need for additional research in diverse settings using rigorous randomization methods.

Conclusion

In conclusion, the analyzed regimen of low-dose esketamine combined with propofol effectively decreases propofol-related injection pain and enhances early postoperative recovery in pediatric strabismus surgery. These outcomes underscore the potential for this combination to improve perioperative experiences while ensuring stability and safety during the surgical process.

Key Points

- The study investigates the efficacy of low-dose esketamine (0.2 mg/kg) in conjunction with propofol (2.5 mg/kg) to alleviate propofol-induced injection pain (PIP) in pediatric patients (ages 3-15) undergoing strabismus surgery, addressing the challenges of insufficient cooperation in young children during anesthesia.

- A total of 84 children were randomly assigned to receive either the esketamine-propofol combination or a control treatment of saline and propofol. Key outcomes assessed included PIP incidence, early postoperative recovery measures, hemodynamic stability (heart rate and mean arterial pressure), and the occurrence of perioperative adverse events like emergence agitation and oculocardiac reflex.

- Results reveal a significant reduction in PIP incidence in the esketamine group (56.1%) compared to the control group (87.5%), alongside a decrease in moderate-to-severe pain reports immediately postoperatively; however, pain levels between both groups normalized by postoperative days 3 and 7.

- Hemodynamic stability post-induction was maintained across both groups, with no significant differences noted, although reductions were observed. Enhanced anesthetic quality and patient comfort were indicated by lower instances of emergence agitation, oculocardiac reflex, and extubation coughing in the esketamine group.

- The study acknowledges limitations, including a small sample size and being conducted at a single center, which may limit the broader applicability of the findings. Additionally, the absence of follow-up data pertaining to long-term outcomes and quality of life presents a gap for further investigation.

- Conclusively, the combination of low-dose esketamine with propofol demonstrates efficacy in reducing PIP and improving early postoperative recovery in pediatric strabismus surgery, indicating potential benefits for enhancing the perioperative experience while ensuring stability and safety during the procedure.

Reference –

Yaping Shen et al. (2025). Low-Dose Esketamine Combined With Propofol In Microscopic Pediatric Strabismus Surgery: A Randomized Controlled Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03095-x.