Effect of Low-Dose Esketamine Combined with Propofol on Postoperative Fatigue in Colonoscopy: A Randomized Clinical Trial

Xuemei Sun, Qiuling Du, Yongjie Liang, Lili Tang, Qingfeng Wei, Peipei Guo, Xuesheng Liu Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 23002, People’s Republic of ChinaCorrespondence: Xuesheng Liu, Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, People’s Republic of China, Tel +86055162922057, Email [email protected]: Postoperative fatigue (POF) is a common occurrence following colonoscopy, primarily attributed to bowel preparation and endoscopic probe stimulation, and is associated with worse postoperative outcomes. Esketamine, an antidepressant anesthetic, has shown the potential to enhance postoperative recovery through various mechanisms. We hypothesized that the low-dose esketamine could alleviate POF in outpatients undergoing colonoscopy.Methods: 200 participants scheduled for painless colonoscopy were enrolled, with 151 patients included in the primary endpoint analysis. Patients were randomly received 0.15 mg/kg esketamine or 0.1 μg/kg sufentanil before anesthesia induction. The primary outcome was the incidence of POF, assessed using the Identity-Consequence Fatigue Scale-10 (ICFS-10) scores at 30 min after colonoscopy. Secondary outcomes included ICFS-10 scores at baseline and 1 day post-colonoscopy, time to discharge and patients’ satisfaction.Results: The incidence of POF was significantly lower in the esketamine group (Group E) compared to the sufentanil group (Group S) (28% vs 44%, P = 0.036). There were no significant differences in ICFS-10 scores between the two groups at baseline and 1 day post-colonoscopy. However, discharge time was significantly shorter in Group E than in Group S (25 min vs 30 min, P = 0.001). In Group E, there was improved hemodynamic stability and greater patients’ satisfaction.Conclusion: The administration of esketamine significantly reduced the incidence of POF and shortened discharge time in patients undergoing colonoscopy. A regimen of 0.15 mg/kg esketamine combined with propofol proved to be an effective anesthesia strategy for painless colonoscopy.Keywords: esketamine, postoperative fatigue, colonoscopy