{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T08:22:00Z","timestamp":1775809320194,"version":"3.50.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Anesthetics such as propofol, esketamine and nalbuphine are used during the upper gastrointestinal endoscopy to achieve and maintain the desired sedation level. The aim of the study was to evaluate the effectiveness and safety of propofol-nalbuphine and propofol-esketamine in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multi-centered study was performed at three tertiary class-A hospitals. Children between 3 and 12 years old undergoing diagnostic painless upper gastrointestinal endoscopy were included and randomly divided into esketamine or nalbuphine group to estimate the primary outcome of successful endoscope insertion. The patients were given esketamine 0.5\u2005mg\/kg and propofol 2\u2005mg\/kg intravenously in esketamine group, with nalbuphine 0.2\u2005mg\/kg and propofol 2\u2005mg\/kg in the nalbuphine group. The primary outcome was success rate for the first attempt of endoscope insertion in each group. Secondary outcomes included the safety of both anesthesia regimens and gastroenterologist's satisfaction. We used the Face, Leg, Activity, Cry and Consolability (FLACC) scale to evaluate the level of pain before and during the procedure and the Pediatric Anesthesia Emergence Delirium (PAED) scale to assess the level of agitation and delirium after awakening from anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 246 patients, 200 were randomly included in the final intention-to-treat analysis, with 100 patients in each group. The success rate for the first attempt of endoscope insertion in the esketamine group was higher than the nalbuphine group (97% vs. 66%; <jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.01). The heart rate and mean arterial pressure after intraoperative administration in the esketamine group were higher than those in the nalbuphine group, while the delirium incidence during awakening was higher in esketamine group (all <jats:italic>P\u2009<\/jats:italic>&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The success rate for the first attempt of endoscope insertion of children undergoing upper gastrointestinal endoscopy in the esketamine group was higher than the nalbuphine group, propofol-related hemodynamic changes were reduced accordingly, while the incidence of esketamine-related adverse effects could be high.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>Chinese Clinical Trial Registry: ChiCTR2000040500.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1126522","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T15:13:44Z","timestamp":1687878824000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial"],"prefix":"10.3389","volume":"11","author":[{"given":"Xiaosu","family":"Zheng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinjin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sisi","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingying","family":"Tao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pan","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazhong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.bja.2021.01.028","article-title":"National survey on sedation for gastrointestinal endoscopy in 2758 Chinese hospitals","volume":"127","author":"Zhou","year":"2021","journal-title":"Br J Anaesth"},{"key":"B2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12876-020-01561-z","article-title":"Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations","volume":"21","author":"Dossa","year":"2021","journal-title":"BMC Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.giec.2022.10.001","article-title":"The evolution of sedation for pediatric gastrointestinal endoscopy","volume":"33","author":"Mahoney","year":"2023","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.giec.2016.02.004","article-title":"Sedation and monitoring in the pediatric patient during gastrointestinal endoscopy","volume":"26","author":"Chung","year":"2016","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"B5","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1213\/00000539-199610000-00008","article-title":"A comparative study of early postoperative hypoxemia in infants, children, and adults undergoing elective plastic surgery","volume":"83","author":"Xue","year":"1996","journal-title":"Anesth Analg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"467","DOI":"10.18926\/AMO\/56244","article-title":"The incidence of desaturation during anesthesia in adult and pediatric patients: a retrospective study","volume":"72","author":"Vika Fatafehi Hala'ufia","year":"2018","journal-title":"Acta Med Okayama"},{"key":"B7","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1034\/j.1399-6576.2003.00040.x","article-title":"Inhibitory effect of propofol on ketamine-induced c-Fos expression in the rat posterior cingulate and retrosplenial cortices is mediated by GABAA receptor activation","volume":"47","author":"Nakao","year":"2003","journal-title":"Acta Anaesthesiol Scand"},{"key":"B8","doi-asserted-by":"publisher","first-page":"7443226","DOI":"10.1155\/2023\/7443226","article-title":"Ciprofol: a novel alternative to propofol in clinical intravenous anesthesia?","volume":"2023","author":"Lu","year":"2023","journal-title":"Biomed Res Int"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.3390\/jcm12041320","article-title":"Which adverse events and which drugs are implicated in drug-related hospital admissions? A systematic review and meta-analysis","volume":"12","author":"Haerdtlein","year":"2023","journal-title":"J Clin Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1002\/lary.25399","article-title":"The effects of anesthesia and opioids on the upper airway: a systematic review","volume":"126","author":"Ehsan","year":"2016","journal-title":"Laryngoscope"},{"key":"B11","doi-asserted-by":"publisher","first-page":"673550","DOI":"10.3389\/fphar.2021.673550","article-title":"Effective doses of nalbuphine combined with propofol for painless gastroscopy in adults: a randomized controlled trial","volume":"12","author":"Li","year":"2021","journal-title":"Front Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1038\/sj.bjp.0705763","article-title":"Peripheral kappa-opioid agonists for visceral pain","volume":"141","author":"Rivi\u00e8re","year":"2004","journal-title":"Br J Pharmacol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/00000542-198211000-00004","article-title":"Analgesic and respiratory depressant activity of nalbuphine: a comparison with morphine","volume":"57","author":"Gal","year":"1982","journal-title":"Anesthesiology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/j.1365-2044.1985.tb10888.x","article-title":"Self-administered nalbuphine, morphine and pethidine. Comparison, by intravenous route, following cholecystectomy","volume":"40","author":"Bahar","year":"1985","journal-title":"Anaesthesia"},{"key":"B15","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1093\/bja\/aer001","article-title":"Population pharmacokinetics of nalbuphine after surgery in children","volume":"106","author":"Bressolle","year":"2011","journal-title":"Br J Anaesth"},{"key":"B16","doi-asserted-by":"publisher","first-page":"4135","DOI":"10.2147\/DDDT.S224553","article-title":"Pharmacokinetics and safety of esketamine in Chinese patients undergoing painless gastroscopy in comparison with ketamine: a randomized, open-label clinical study","volume":"13","author":"Wang","year":"2019","journal-title":"Drug Des Devel Ther"},{"key":"B17","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1124\/pr.117.015198","article-title":"Ketamine and ketamine metabolite pharmacology: insights into therapeutic mechanisms","volume":"70","author":"Zanos","year":"2018","journal-title":"Pharmacol Rev"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.4103\/jfmpc.jfmpc_890_19","article-title":"A review on the recent application of ketamine in management of anesthesia, pain, and health care","volume":"9","author":"Abdollahpour","year":"2020","journal-title":"J Family Med Prim Care"},{"key":"B19","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/0952-8180(93)90081-O","article-title":"The effect of nalbuphine and droperidol on spontaneous movements during induction of anesthesia with propofol in children","volume":"5","author":"Borgeat","year":"1993","journal-title":"J Clin Anesth"},{"key":"B20","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1111\/bcpt.13022","article-title":"The ED95 of nalbuphine in outpatient-induced abortion compared to equivalent sufentanil","volume":"123","author":"Chen","year":"2018","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1014486","DOI":"10.3389\/fphar.2022.1014486","article-title":"The median effective doses of propofol combined with two different doses of nalbuphine for adult patients during painless gastroscopy","volume":"13","author":"Tang","year":"2022","journal-title":"Front Pharmacol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e0188901","DOI":"10.1371\/journal.pone.0188901","article-title":"Comparison of nalbuphine and sufentanil for colonoscopy: a randomized controlled trial","volume":"12","author":"Deng","year":"2017","journal-title":"PLoS One"},{"key":"B23","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1097\/ALN.0b013e3181ed09a2","article-title":"Taming the ketamine tiger. 1965","volume":"113","author":"Domino","year":"2010","journal-title":"Anesthesiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1111\/bcp.12094","article-title":"Ketamine for chronic pain: risks and benefits","volume":"72","author":"Niesters","year":"2013","journal-title":"Br J Clin Pharmacol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1515\/med-2022-0509","article-title":"Advantages of ketamine in pediatric anesthesia","volume":"17","author":"Simonini","year":"2022","journal-title":"Open Med (Wars)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1007\/s40262-016-0383-6","article-title":"Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy","volume":"55","author":"Peltoniemi","year":"2016","journal-title":"Clin Pharmacokinet"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1111\/jcpt.13635","article-title":"ED50 And ED95 of propofol combined with different doses of esketamine for children undergoing upper gastrointestinal endoscopy: a prospective dose-finding study using up-and-down sequential allocation method","volume":"47","author":"Zheng","year":"2022","journal-title":"J Clin Pharm Ther"},{"key":"B28","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1016\/j.gie.2015.08.077","article-title":"A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP","volume":"83","author":"Goyal","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"B29","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.bja.2021.03.022","article-title":"High-flow nasal oxygen for gastrointestinal endoscopy improves respiratory safety","volume":"127","author":"Santer","year":"2021","journal-title":"Br J Anaesth"},{"key":"B30","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jped.2019.08.011","article-title":"Propofol use in newborns and children: is it safe? A systematic review","volume":"96","author":"Filho","year":"2020","journal-title":"J Pediatr (Rio J)"},{"key":"B31","doi-asserted-by":"publisher","first-page":"3160154","DOI":"10.1155\/2021\/3160154","article-title":"Incidence of adverse effects of propofol for procedural sedation\/anesthesia in the pediatric emergency population: a systematic review and meta-analysis","volume":"2021","author":"Guo","year":"2021","journal-title":"Comput Math Methods Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"116","DOI":"10.2174\/1567201816666190313160438","article-title":"Comparison of fentanyl, remifentanil, sufentanil and alfentanil in combination with propofol for general anesthesia: a systematic review and meta-analysis of randomized controlled trials","volume":"14","author":"Sridharan","year":"2019","journal-title":"Curr Clin Pharmacol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/j.1460-9592.1996.tb00347.x","article-title":"Observation of early postoperative hypoxaemia in children undergoing elective plastic surgery","volume":"6","author":"Xue","year":"1996","journal-title":"Paediatr Anaesth"},{"key":"B34","doi-asserted-by":"publisher","first-page":"43","DOI":"10.4097\/kjae.2018.71.1.43","article-title":"Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography","volume":"71","author":"Singh","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s00101-014-2293-z","article-title":"Nalbuphin in der Kinderan\u00e4sthesie [Nalbuphine in pediatric anesthesia]","volume":"63","author":"Schultz-Machata","year":"2014","journal-title":"Anaesthesist"},{"key":"B36","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1093\/bja\/58.6.625","article-title":"Respiratory function following nalbuphine and morphine in anaesthetized man","volume":"58","author":"Klepper","year":"1986","journal-title":"Br J Anaesth"},{"key":"B37","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1213\/ANE.0000000000004967","article-title":"Safety and efficacy of the combination of propofol and ketamine for procedural sedation\/anesthesia in the pediatric population: a systematic review and meta-analysis","volume":"132","author":"Hayes","year":"2021","journal-title":"Anesth Analg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"2706","DOI":"10.1002\/ppul.24975","article-title":"High-flow nasal cannula vs standard respiratory care in pediatric procedural sedation: a randomized controlled pilot trial","volume":"55","author":"Klotz","year":"2020","journal-title":"Pediatr Pulmonol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1213\/01.ane.0000200282.38041.1f","article-title":"Prevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia","volume":"102","author":"Dalens","year":"2006","journal-title":"Anesth Analg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1016\/j.bja.2021.08.036","article-title":"Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials","volume":"128","author":"Hung","year":"2022","journal-title":"Br J Anaesth"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1126522\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T15:13:48Z","timestamp":1687878828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1126522\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":40,"alternative-id":["10.3389\/fped.2023.1126522"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1126522","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,27]]},"article-number":"1126522"}}