Comparing The Safety And Efficacy Of Esketamine With Propofol In Intravenous Anesthesia For ERCP:A Prospective,Randomized,Controlled Trial

Objective:To observe the safety and effectiveness of intravenous esketamine combined with alfentanil in ERCP.Methods:Sixty patients undergoing ERCP surgery were randomly divided into group ESK and group PRO,with 30 cases in each group.Before anesthesia induction,all the patients received a bolus of 10μg/kg alfentanil intravenously followed by continuous infusion of 0.03～0.12 mg/kg/h during the operation.The patients in group ESK received a bolus of 0.5 mg/kg esketamine combined with 10μg/kg alfentanil followed by continuous infusion of 0.3mg/kg/h esketamine and 0.03～0.12 mg/kg/h alfentanil for maintenance during the operation,whereas the group PRO received2mg/kg propofol intravenously followed by continuous infusion of 4～8 mg/kg/h with the same dosage of alfentanil.The vital signs of patients were recorded at predefined time points during the standardized surgical procedure:T0（before anesthesia）,T1（during portal insertion）,T2（intraoperative sphincterotomy）,and T3（postoperative revival）.The time of respiratory depression after anesthesia induction,involuntary movement,the dosage of dopamine,the recovery time of anesthesia,the recovery time of directional force,the visual analog scale and the adverse events were also recorded.Results:There was no significant difference in the vital signs at T0 and T3 between the two group（P>0.05）.Compared with the group PRO,the MAP,HR,RR,Sp O₂,RE/SE in the group ESK were higher at T1-T2（P<0.01）;Compared with the group PRO,The time of respiratory depression after anesthesia induction in the group ESK was significantly shorter than that in group PRO（P<0.01）;The recovery time of anesthesia and the recovery time of directional force in the group ESK were shorter than those in the group PRO（P<0.01）;Involuntary movement was less common in the group ESK than that in the group PRO（P<0.01）;The total dose of dopamine and the VAS were significantly decreased in the group ESK（P<0.01）.Conclusion:Intravenous esketamine combined with alfentanil can significantly decrease involuntary movement during ERCP,contributing to hemodynamic stability,with better analgesic quality and controllability,it is safe and effective for ERCP anesthesia.