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.

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 2 mg/kg + sufentanil 0.1 μg/kg), PE1 (propofol 2 mg/kg + esketamine 0.05 mg/kg), PE2 (propofol 2 mg/kg + esketamine 0.1 mg/kg), and PE3 (propofol 2 mg/kg + esketamine 0.2 mg/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 ( 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.