Evaluation of the effective sedative dose and safety of esketamine combined with midazolam for caudal anesthesia puncture in children

LI Ting; HAN Ying; ZHANG Xiao-die; ZHAO Jia-lian; RU Wei; HU Yao-qin

doi:10.13820/j.cnki.gdyx.20251211

Abstract：Objective To determine the median effective dose(ED50)and 95％effective dose(ED95)of esket-amine for sedation during caudal anesthesia puncture in children when combined with 0.1 mg/kg midazolam.Methods A total of 146 pediatric patients undergoing caudal puncture under sedation with esketamine(0.5-1.3 mg/kg)combined with 0.1 mg/kg midazolam were enrolled.Patients were divided into four age groups:＜3 years(G1,n=56),3-6 years(G2,n=32),6-8 years(G3,n=19),and 8-12 years(G4,n=39).Probit regression analysis was used to estimate the ED50 and ED95 of esketamine in each group.Results The ED50 and ED95 values of esketamine were as fol-lows:＜3 years:ED50=0.960 mg/kg(95％CI:0.798-1.250 mg/kg),ED95=1.718 mg/kg(95％CI:1.374-2.727 mg/kg);3-6 years:ED50=1.119 mg/kg(95％CI:0.901-1.487 mg/kg),ED95=1.877 mg/kg(95％CI:1.502-2.940 mg/kg);6-8 years:ED50=1.042 mg/kg(95％CI:0.755-1.482 mg/kg),ED95=1.800 mg/kg(95％CI:1.393-2.897 mg/kg);8-12 years:ED50=0.981 mg/kg(95％CI:0.786-1.245 mg/kg),ED95=1.739 mg/kg(95％CI:1.410-2.675 mg/kg).No statistically significant differences in ED50 or ED95 were observed among the groups(P＞0.05),although individual dose-response variability was significant(P＜0.05).Intraoperative respiratory depression occurred in 6 children,and 4 children experienced vomiting during or after the procedure.Conclusion When combined with 0.1 mg/kg midazolam,esketamine has an ED50 of 1.019 mg/kg and an ED95 of 1.818 mg/kg for sedation during caudal anesthesia puncture in children aged 1 month to 12 years.This regimen is safe for pediatric sedation during caudal puncture.However,due to marked individual variability in dose-response,esketamine should be administered at low doses,titrated carefully,and used in combination with other sedatives.