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

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.

Inclusion criteria

• Age 6 to 12 years, both sexes;
• American Society of Anesthesiologists (ASA) physical status I or II;
• Scheduled for elective gastroscopy or esophagogastroduodenoscopy (EGD) under anesthesia;
• Preoperative oxygen saturation of 100% while breathing room air;
• Weight within the normal range for age and gender according to the following reference values (inclusive of endpoints)

Exclusion criteria

• Contraindications to sedation or anesthesia, or a history of adverse events related to sedation/anesthesia；
• Known or suspected allergy to the study drug, benzodiazepines, or their reversal agents；
• History of respiratory disease within the past 2 weeks, or known difficult airway (modified Mallampati score III or IV)；
• History of cardiac, hepatic, renal dysfunction, or metabolic diseases；
• Patients with congenital diseases or other conditions that may interfere with the evaluation of efficacy outcomes.