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Dose-dependent effect of esketamine on preventing rocuronium-induced limb withdrawal in preschool children

Jie Wang1, Zhiguo Zhou1, Wen-Lu Ma1

  • 1Department of Surgical Anesthesia, Hangzhou Children's Hospital, China.

Advances in Clinical and Experimental Medicine : Official Organ Wroclaw Medical University
|July 29, 2026
PubMed

Insights

Pre-anesthesia esketamine effectively reduces rocuronium-induced limb withdrawal reactions in preschool children. A 0.1 mg/kg dose of esketamine significantly lowered reaction incidence and severity during anesthesia induction.

Area of Science:

  • Anesthesiology
  • Pediatric Pharmacology
  • Pain Management

Background:

  • Rocuronium injection commonly causes limb withdrawal reactions in preschool children during anesthesia induction.
  • These reactions can lead to adverse effects, necessitating mitigation strategies.
  • The optimal dose of esketamine for preventing these reactions is not well-established.

Purpose of the Study:

  • To evaluate the efficacy of different prophylactic esketamine doses in mitigating rocuronium-induced limb withdrawal reactions.
  • To compare the incidence and severity of limb withdrawal reactions across varying esketamine dosages.
  • To assess the impact of esketamine on hemodynamic parameters during anesthesia induction.

Main Methods:

  • Ninety preschool children (2-6 years, ASA I-II) undergoing elective surgery were randomized into three groups: control (saline), esketamine 0.1 mg/kg, and esketamine 0.2 mg/kg.
  • Esketamine or saline was administered intravenously 30 seconds prior to rocuronium injection.
  • Mean arterial pressure (MAP) and heart rate (HR) were monitored, along with the incidence and severity of limb withdrawal reactions.

Main Results:

  • The incidence of limb withdrawal reactions was significantly lower in the esketamine groups (16.67% for 0.1 mg/kg, 13.33% for 0.2 mg/kg) compared to the control group (43.33%).
  • Both incidence and severity of limb withdrawal reactions showed statistically significant differences among the three groups.
  • Hemodynamic parameters (MAP and HR) showed varied changes, with significant increases noted in the control group post-rocuronium and in the 0.2 mg/kg esketamine group at specific time points.

Conclusions:

  • Prophylactic intravenous administration of 0.1 mg/kg esketamine is effective in reducing limb withdrawal reactions caused by rocuronium injection in preschool children.
  • The 0.1 mg/kg dose of esketamine appears to be an optimal choice for mitigating these reactions.
  • Further research may explore the 0.2 mg/kg dose's specific hemodynamic effects and long-term implications.
Abstract

Keywords:
drug dose–response relationshipesketamineinjection painpediatric anesthesiarocuronium bromide

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