Effect of different doses of esketamine on the median effective concentration of propofol for inhibiting body movement during hysteroscopy

• Published in: Scientific reports Vol. 14; no. 1; pp. 25153 - 12
• Main Authors: Wan, Ji-Xiang, Zeng, Si-Si, Wu, Zhi-Qiang, Wang, Yuan, Wang, Na, Wang, Fang-Jun
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 24.10.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 631/154; 631/154/436; 692/308; 692/308/2779; Adult; Anesthesia; Anesthetics; Anesthetics, Intravenous - administration & dosage; Anxiety; Clinical trials; Dose-Response Relationship, Drug; Double-Blind Method; Drug Interactions; EC50; Esketamine; Female; Hospitals; Humanities and Social Sciences; Humans; Hypertension; Hysteroscopy; Hysteroscopy - methods; Injection; Intravenous administration; Ketamine; Ketamine - administration & dosage; Mental depression; Midazolam; Middle Aged; Movement - drug effects; multidisciplinary; Narcotics; Patients; Pharmacodynamics; Propofol; Propofol - administration & dosage; Prospective Studies; Registration; Science; Science (multidisciplinary); Surgery; Esketamine; Hysteroscopy; Propofol; Anesthetics; EC; EC50
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-75902-3

The objective of this study is to investigate the effects of various doses of esketamine on the median effective concentration (EC 50 ) of propofol required for inhibiting body movement during hysteroscopy. Additionally, this research aims to explore the pharmacodynamic interactions between esketamine and propofol. Prospective, double-blind, up-down sequential allocation study. Operating room, post-anesthesia care unit (PACU), and general ward. A total of 90 patients were allocated into three groups in a randomized, double-blinded manner as follows: 0.1 mg/kg esketamine combined with propofol intravenous injection (EP 0.1 ) group, 0.2 mg/kg esketamine combined with propofol intravenous injection (EP 0.2 ) group, 0.3 mg/kg esketamine combined with propofol of intravenous injection (EP 0.3 ) group. For the initial patient in each group, the starting effector target concentration of propofol was set at 4 µg/ml. Each patient received an initial intravenous injection of 0.04 mg/kg midazolam, followed by the administration of the appropriate dose of esketamine. Ten seconds after the esketamine injection, propofol was administered intravenously to achieve the target concentration. In accordance with the sequential method principle, the concentration of propofol for the subsequent patient was adjusted based on the response of the previous patient. Effective inhibition of body movement was defined as the absence of any involuntary body movements throughout the entire surgical process. If the previous patient exhibited body movements, the propofol concentration for the next patient was increased by 0.5 µg/ml; conversely, if no movements were observed, it was decreased by 0.5 µg/ml. The up-down sequential allocation method and probit regression were used to calculate the EC 50 of propofol. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Depression (HADS-D) score, adverse events, hemodynamic changes, demographic data and clinical characteristics. The EC 50 of propofol was 3.849 μg/ml (95% CI : 3.419–4.281) in the EP 0.1 group, 3.641 μg/ml (95% CI : 2.807−4.200) in the EP 0.2 group, and 3.417 μg/ml (95% CI : 2.845–3.852) in the EP 0.3 group. These findings suggest that esketamine can dose-dependently reduce the EC 50 of propofol. Esketamine can dose-dependently reduce the EC 50 of propofol in hysteroscopy, while concurrently lowering patients’ HADS-A and HADS-D scores 24 h post-operation. It is concluded that the optimal dose of esketamine, when combined with propofol for hysteroscopy, is 0.3 mg/kg.