Clinical Study On The Safety And Efficacy Of Esketamine Combined With Propofol Conscious Sedation During Colonoscopy

Objective:This study compared the safety and efficacy indexes of esketamine combined with propofol conscious sedation,sufentanil combined with propofol conscious sedation,and propofol deep sedation in colonoscopy patients,and evaluated the clinical effects of esketamine combined with propofol for conscious sedation,in order to provide reference for clinical medication.Methods:In this study,195 patients underwent painless colonoscopy in the digestive endoscopy room of the First Affiliated Hospital of Hunan University of Medicine from October 1,2022 to February 28,2023,65 patients in each group,age 18-60years old,gender not limited,ASA level I/II,BMI 18～25 kg/m².They were randomly divided into group DS（propofol deep sedation）,group CS₁（sufentanil combined with propofol conscious sedation）and group CS₂（esketamine combined with propofol conscious sedation）,respectively.Patients in group DS were given propofol1.5～2.0mg/kg to maintain the target sedation level score MOAA/S≤2.Patients in group CS₁and group CS₂were given sufentanil 0.1μg/kg,esketamine 0.2mg/kg,respectively,combined with propofol 0.5～0.8mg/kg to maintain the target sedation level score MOAA/S 4 or 5.In case of significant limb movement during colonoscopy,all patients were given an additional dose of 0.3mg/kg propofol,with each administration interval of at least 1 minute.Patients entered the examination room to establish venous channels,and monitored oxygen saturation（Sp O₂）,heart rate（HR）,blood pressure（BP）,and respiration rate（RR）.Adverse events such as hypoxemia,hypotension,hypertension and bradycardia were recorded during colonoscopy,as well as the treatment of adverse reactions and the level of anesthesia effect.MAP,HR,Sp O₂at the beginning of induction（T₀）,immediately after colonoscopy implantation（T₁）,immediately before tracheal intubation（T₂）,colonoscopy transsplenic flexural（T₃）,the end of colonoscopy in patients(T₄)were recorded.The time of anesthesia induction,the time of reaching discharge standard,the occurrence of PONV,drowsiness,dizziness during and after recovery,the incidence of propofol infusion pain,times of additional propofol,the satisfaction of endoscopists and patients were recorded.One-way analysis of variance was used to compare the general situation,Sp O₂,MAP,HR in key time points,the time of anesthesia induction,the time of reaching discharge standard,endoscopist and patient satisfaction,and times of additional propofol among the three groups.χ2 test was used to compare the incidence and treatment of hypoxemia,hypotension,hypertension and bradycardia,the good rate of anesthesia effect,the incidence of PONV,drowsiness,dizziness after recovery and propofol infusion pain among the three groups.P<0.05 was considered significant.Results:1.A total of 195 patients were included in this study,with 65 in each group.All patients completed colonoscopy.There were no significant differences in gender,age,body mass index,ASA level,and colonoscopy time among three groups.2.The Sp O₂of group CS₂was significantly higher than group DS at T₁and T₂,（P<0.05）.Sp O₂at T₀,T₃,T₄showed no significant differences.The incidence of intraoperative hypoxemia in group DS was significantly higher than that in groups CS₁and CS₂（P<0.05）.There was no significant difference in incidence of intraoperative hypoxemia between group CS₁and CS₂.3.MAP,HR at T₀showed no significant differences.Compared with MAP between groups,group CS₂was significantly higher than group DS at T₁,T₂,T₃and T₄（P<0.05）,and group CS₂was significantly higher than group CS₁at T₁,T₂and T₃（P<0.05）.The comparison of HR between groups showed that group CS₁was significantly lower than groups DS and CS₂at T₁,T₂,T₃and T₄（P<0.05）.The incidence of intraoperative hypotension in group CS₂was significantly lower than that in groups DS and CS₁（P<0.05）.There was no significant difference in the incidence of hypertension and bradycardia among three groups.4.There was no significant difference in the rate of good and good anesthesia effect,the time of anesthesia induction and times of additional propofol.In group DS,the time of reaching discharge standard were significantly higher than groups CS₁and CS₂（P<0.05）.5.The incidence of drowsiness after awakening,propofol infusion pain and the use ratio of auxiliary ventilation,ephedrine were significantly higher in group DS than in groups CS₁and CS₂（P<0.05）.The incidence of dizziness after recovery in group CS₁was significantly higher than that in groups DS and CS₂（P<0.05）.There was no significant difference in the incidence of PONV after recovery,the use ratio of nitroglycerin and atropine among three groups.6.Comparing endoscopists satisfaction and patient satisfaction between groups,group DS was significantly lower than groups CS₁and CS₂（P<0.05）.Conclusions:1.Esketamine combined with propofol for conscious sedation is safe and effective in painless colonoscopy,with slight respiratory circulation inhibition,stable hemodynamics can be maintained,and significantly reducing the incidence of adverse reactions after recovery.2.Compare with sufentanil combined with propofol for conscious sedation,esketamine combined with propofol for conscious sedation maintained higher blood pressure and a lower incidence of hypotension and a lower incidence of dizziness during colonoscopy.