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CLINICAL TRIAL article

Front. Pharmacol.
Sec. Neuropharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1419732

Determining the effective dose of esketamine combined with propofol for painless hysteroscopy: A prospective dose-finding study

Provisionally accepted
Zhimin Sheng Zhimin Sheng 1Xiang Liu Xiang Liu 1Kang Lin Kang Lin 2Jie Liu Jie Liu 1Junqin Mao Junqin Mao 1Xiaowei Qian Xiaowei Qian 3*
  • 1 Department of Anesthesiology, Wenling Maternal and Child Health Care Hospital, Wenling, China
  • 2 Department of Anesthesiology, First People's Hospital of Wenling, Wenling, China
  • 3 Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    Background: The combination of esketamine and propofol has become a common choice for total intravenous anesthesia in hysteroscopic procedures. However, the optimal effective dose has not yet been determined. The aim of this study was to determine the median effective dose (ED50) and 95% effective dose (ED95) of esketamine compounded with propofol for painless hysteroscopy. Methods: A total of 40 patients aged 20-60 years and scheduled for painless hysteroscopy under intravenous anesthesia were recruited, and a total of 31 patients were enrolled for the final analysis. Using the Dixon's up and down method, an initial dose of 0.5 mg/kg esketamine was administered intravenously before surgery, and after 1 minute, it was followed by 2 mg/kg of propofol. If the hysteroscopy failed (a positive reaction) [defined as inadequate cervical dilatation, patient body movements interfering with surgical procedures during hysteroscopy placement, frowning, or Ramsay Sedation Scale (RSS) score < 5 within 5 minutes], the subsequent patient's esketamine dosage was increased by 0.1 mg/kg. Conversely (a negative reaction), the dosage was decreased by 0.1 mg/kg. The test was not stopped until at least 7 crossovers occurred. The perioperative adverse events of each patient were recorded. The ED50 and ED95 with 95% confidence intervals (CIs) were estimated using probit regression. Results: The ED50 and ED95 with 95% (CIs) of esketamine in patients were 0.287 (0.220-0.342) mg/kg and 0.429 (0.365-0.705) mg/kg, respectively. No serious adverse events were observed in any patients. Conclusion: A dose of 0.429 mg/kg esketamine combined with propofol is recommended for painless hysteroscopy anesthesia, as it enhances anesthesia and postoperative analgesia efficacy without significant adverse reactions. However, potential risks associated with this dosage should be carefully considered in clinical practice.

    Keywords: dose-response, Dixon's up and down method, esketamine-propofol combination, 95% effective dose (ED95), painless hysteroscopy

    Received: 03 Jun 2024; Accepted: 04 Dec 2024.

    Copyright: © 2024 Sheng, Liu, Lin, Liu, Mao and Qian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xiaowei Qian, Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.