Comparing Esketamine and Remazolam With Propofol for Breathing Safety in Pediatric Gastroscopy

Overview

Gastroscopy is important for diagnosing and treating upper gastrointestinal diseases in children. To ensure the procedure is safe and smooth, most children require sedation. Compared to adults, children have more fragile airways, lower lung capacity, and poorer oxygen reserves, making them more prone to breathing difficulties and low oxygen levels during sedation. Esketamine, a stronger form of ketamine, helps maintain heart rate and blood pressure and may reduce breathing-related risks. Remimazolam, a new short-acting sedative, acts quickly, allows faster recovery, and has a better safety profile than propofol-it doesn't cause breathing problems or injection pain. The safety and effectiveness of combining remimazolam with esketamine for pediatric gastroscopy have not been well studied. This research will compare this new combination with the traditional propofol-based approach to evaluate its potential benefits and safety in children.

Children scheduled for elective gastroscopy under general anesthesia were randomly allocated into two groups: the RA group (Remimazolam Besylate + Esketamine), consisting of 60 cases, and the PF group (Propofol + Fentanyl), also consisting of 60 cases. The induction doses for the RA group were: Remimazolam Besylate 0.65 mg/kg + Esketamine 0.5 mg/kg. The induction doses for the PF group were: Propofol 3 mg/kg + Fentanyl 2 μg/kg. In the RA group, Esketamine 0.5 mg/kg was administered as a single intravenous bolus over 10 seconds. In the PF group, Fentanyl 2 μg/kg was administered as a single intravenous bolus over 10 seconds. After a 1-minute waiting period for both groups, Remimazolam Besylate 0.65 mg/kg was administered intravenously over 15 seconds in the RA group, while Propofol 3 mg/kg was administered intravenously over 15 seconds in the PF group. Gastroscopy commenced once the child's eyelash reflex disappeared and the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score was ≤1. The following parameters were recorded: the time from intravenous induction drug administration to loss of consciousness; the incidence of respiratory adverse events during anesthesia (defined as SpO₂ \<92% lasting ≥30 seconds, apnea, laryngospasm, or severe/persistent coughing); the success rate of intravenous anesthetic sedation; total gastroscopy procedure time; time to emergence from anesthesia; the incidence of postoperative agitation; MOAA/S scores; and vital signs including heart rate, blood pressure, and pulse oxygen saturation.