Median effective dose of esketamine combined with propofol in inhibiting body movement response during pediatric patients undergoing photodynamic therapy for port wine stains

CHEN Peipei; FENG Yankun; CHEN Zhijun; WANG Jiafang

doi:10.3969/j.issn.2096-2681.2025.02.006

Abstract：Objective To explore the median effective dose(ED50)of esketamine combined with propofol to inhibit body movement during pediatric patients undergoing photodynamic therapy for port wine stains.Methods Thirty-three pediatric patients of either gender,aged 3-6 years,ASA Ⅰ or Ⅱ,with port wine stains who had received photodynamic therapy at Wuhan No.1 Hospital from July to August 2024 were selected and divided into positive group(n=17):with a body movement response＞Grade 1 and negative group(n=16):with a body movement response≤Grade 1,according to the body movement response.Before treatment,the pediatric patients were given penehyclidine hydrochloride(0.01 mg/kg)and propofol(3 mg/kg)for anesthesia induction,and were continuously pumped propofol 6 mg/(kg·h)to maintain anesthesia.The first pediatric patient was given esketamine(0.5 mg/kg)before irradiation and the esket-amine dosage of other pediatric patients was determined using improved sequential test method.If the previous pediatric patient had a posi-tive reaction on photodynamic therapy(body movement＞Grade 1),the esketamine dosage of the next pediatric patient was increased by a dose gradient of 0.05 mg/kg,and vice versa was decreased by 0.05 mg/kg.The study was terminated when seven cross-inflection points of the sequential test method were found.Probit regression analysis was used to calculate ED50,95％effective dose(ED95)and 95％CI when the esketamine combined with propofol inhibited the body movement response during pediatric patient undergoing photody-namic therapy for port wine stains.The MAP,HR and SpO2 at pre-induction(T0),immediately before irradiation(T1),5 minutes after irradiation(T2),10 minutes after irradiation(T3)and end of irradiation(T4)were recorded.The body movement grade,awakening time,and the FLACC score and adverse reactions at 15 minutes after awakening were recorded.Results Compared with the basic value,the MAP and HR of the patients of two groups were decreased after administration,and the fluctuation range was small.The difference was statistically significant(P＜0.05),subsequently,the MAP and HR were increased,with statistical significance(P＜0.05).There was one case of hypoxemia in the negative group,and no obvious adverse reactions in the positive group.The ED50 value and ED95 value of es-ketamine were 0.593 mg/kg(95％CI0.540-0.644)and 0.712 mg/kg(95％CI0.655-1.067)respectively.Conclusion When the esketamine combined with propofol inhibits the body movement response during pediatric patients undergoing photodynamic therapy for port wine stains,the ED50 value is 0.593 mg/kg(95％CI0.540-0.644),which can provide a reference for clinic application.