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The median effective concentration of propofol with different doses of esketamine during gastrointestinal endoscopy in elderly patients: A randomized controlled trial
Author(s) -
Yang Hua,
Zhao Qian,
Chen Haiyan,
Liu Wen,
Ding Tong,
Yang Bin,
Song JinChao
Publication year - 2022
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.15072
Subject(s) - propofol , medicine , anesthesia , ketamine , bolus (digestion) , endoscopy
Aims Propofol may result in hypotension, bradycardia and loss of protective reflexes, especially in elderly patients, while esketamine, a N‐methyl‐D‐aspartate receptor antagonist, has analgesic, anaesthetic and sympathomimetic properties and is known to cause less cardiorespiratory depression. We hypothesized that esketamine may reduce the median effective concentration (EC 50 ) of propofol and coadministration is less likely to produce hypotension during gastrointestinal endoscopy in elderly patients. Methods Ninety elderly patients, aged 65–89 years, undergoing gastrointestinal endoscopy were randomly assigned into 3 groups: SK0 (control) group (0 mg/kg esketamine); SK0.25 group (0.25 mg/kg esketamine); and SK0.5 group (0.5 mg/kg esketamine). Anaesthesia was achieved by plasma target‐controlled infusion of propofol with different bolus doses of esketamine. The EC 50 of propofol for gastrointestinal endoscopy was determined by using the up‐and‐down method of Dixon. The initial plasma target concentration is 2.5 μg/mL and the adjacent concentration gradient is 0.5 μg/mL. Cardiovascular variables were also measured. Results Propofol EC 50 s and its 95% confidence interval for gastrointestinal endoscopy in elderly patients were 3.69 (2.59–4.78), 2.45 (1.85–3.05) and 1.71 (1.15–2.27) μg/mL in the SK0, SK0.25 and SK0.5 groups, respectively ( P < .05). The average percent change from baseline mean arterial pressure was −19.7 (7.55), −15.2 (7.14) and −10.1 (6.73), in the SK0, SK0.25 and SK0.5 groups, respectively ( P < .001). Conclusion Combination medication of propofol with esketamine reduced the propofol EC 50 during gastrointestinal endoscopy in elderly patients compared with administration of propofol without esketamine. Increasing doses of SK with propofol are less likely to produce hypotension with shorter recovery time.