Effect of Different Doses of Esketamine on the Propofol Effect-Site Concentration Required to Suppress Cervical Dilation-Associated Movement During Hysteroscopy: A Prospective, Randomised, Controlled, Parallel-Group Dose-Response Trial

Background: Operative hysteroscopy is commonly performed under propofol-based intravenous anesthesia, but the relatively high propofol requirement needed to suppress movement during cervical dilation may increase the risk of respiratory and hemodynamic adverse events. Esketamine, the active enantiomer of ketamine, has greater analgesic potency and has been increasingly used as a propofol adjunct; however, its dose-dependent effects on propofol effect-site concentration during hysteroscopy remain unclear. Objective: To determine whether esketamine dose-dependently reduces the propofol effect-site concentration required to suppress movement during cervical dilation in operative hysteroscopy. Methods: ) for suppressing movement during cervical dilation. Secondary outcomes included total propofol consumption, recovery characteristics, and perioperative adverse events. Results: significantly reduced total propofol consumption and decreased the incidences of hypoxemia and hypotension compared with propofol alone. Higher esketamine doses were associated with more transient tachycardia. Recovery time was not clinically prolonged across groups. Conclusion: appears to provide a favorable balance between propofol-sparing efficacy and cardiovascular stability.