Intranasal Esketamine Premedication Reduces Sevoflurane Requirements During Laryngeal Mask Airway Insertion in...

This study evaluated whether intranasal esketamine premedication reduces sevoflurane requirements for laryngeal mask airway (LMA) insertion in young children.

This randomized, double-blind, placebo-controlled trial enrolled 90 children (2-5 years) undergoing elective strabismus surgery. Participants received intranasal premedication with either saline (control), esketamine 0.5 mg/kg, or esketamine 1.0 mg/kg. The primary outcome was the minimum alveolar concentration of sevoflurane needed for successful LMA placement, determined using Dixon's up-and-down method. Secondary outcomes included anesthesia induction quality (4-point cooperation scale), emergence delirium (Pediatric Anesthesia Emergence Delirium scale), emergence time (from sevoflurane discontinuation to purposeful response), behavioral changes at day 3 (Post-Hospitalization Behavior Questionnaire), and adverse events.

Intranasal esketamine produced dose-dependent reductions in sevoflurane requirements: 2.16 ± 0.18% (control), 1.87 ± 0.17% (0.5 mg/kg), and 1.50 ± 0.19% (1.0 mg/kg), representing decreases of 13.4% and 30.6%, respectively. The higher esketamine dose significantly improved induction quality (p=0.002), reduced emergence delirium (13.8% versus 46.4%, p=0.007), and decreased negative postoperative behavioral changes on day 3 (20.7% versus 53.6%, p=0.010). Emergence time and adverse event rates remained similar across groups.

Intranasal esketamine premedication effectively reduces sevoflurane requirements for LMA placement in children in a dose-dependent manner. The 1.0 mg/kg dose provides optimal clinical benefits without prolonging recovery or increasing complications. This approach offers pediatric anesthesiologists a practical method to reduce volatile anesthetic exposure while improving patient outcomes and potentially minimizing anesthetic-related risks.