Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial.
Adding 0.3 mg/kg esketamine to propofol keeps autistic kids safer and stiller during colonoscopy.
01Research in Context
What this study did
Doctors compared two drug mixes for colonoscopy in autistic children.
One mix was propofol plus esketamine. The other was propofol plus sufentanil.
They used a double-blind RCT design so no one knew which child got which mix.
What they found
Kids who got esketamine moved less and breathed better.
Their blood pressure and heart rate stayed steadier too.
The team called the result positive for esketamine.
How this fits with other research
Abulebda et al. (2018) also tested propofol in autistic kids, but paired it with dexmedetomidine for MRI. They saw the same trade-off: propofol gives faster wake-up yet dexmedetomidine keeps vitals calmer.
Li et al. (2019) added midazolam to dexmedetomidine and raised sedation success. Miao et al. (2024) now show a different pair — propofol plus esketamine — can beat sufentanil on safety without extra wake-up time.
Emerson (2013) warned that autistic patients often have more perioperative problems. The new RCT gives a concrete way to cut those problems during colonoscopy.
Why it matters
If you support autistic children who need scopes, ask the anesthesia team about swapping sufentanil for low-dose esketamine. The switch may mean less movement, fewer breathing scares, and smoother vital signs.
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02At a glance
03Original abstract
Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.
Autism research : official journal of the International Society for Autism Research, 2024 · doi:10.1002/aur.3172