Effect of Esketamine Compared with Sufentanil Combined with Propofol in Patients Undergoing First Trimester Surgical Abortion: A Randomized, Double-Blinded Clinical Trial.

Summary

In 197 patients undergoing first-trimester surgical abortion, esketamine with propofol yielded more stable SBP/DBP/MBP and HR than sufentanil, reduced apnea and hypoxemia, and maintained respiratory function; however, dizziness and PONV were more frequent. Findings support esketamine as a respiratory-sparing option for ambulatory gynecologic anesthesia with attention to antiemetic prophylaxis.

Key Findings

• Esketamine maintained more stable intraoperative SBP, DBP, MBP, and HR than sufentanil (all p≤0.014).
• Apnea and hypoxemia events were reduced with esketamine compared to sufentanil.
• Respiratory rate was similar, but PetCO2 parameters favored esketamine indicating better ventilatory stability.
• Dizziness and postoperative nausea and vomiting (PONV) were more frequent with esketamine.

Clinical Implications

Consider esketamine over short-acting opioids for first-trimester abortion sedation to reduce apnea/hypoxemia and hemodynamic swings; integrate multimodal antiemetic prophylaxis and monitor for dizziness.

Limitations

• Single-procedure context limits generalizability to other ambulatory surgeries.
• Increased PONV and dizziness may offset benefits without robust antiemetic protocols.

Future Directions

Compare esketamine-based regimens with multimodal antiemetic strategies, assess recovery profiles and patient satisfaction, and test across broader ambulatory surgical indications.