To evaluate the clinical value of intravenous anesthesia with Esketamine in children undergoing surgery.

A total of 1 296 children undergoing surgery between January 1, 2020 and January 1, 2024 were selected by convenient sampling from two tertiary hospitals in Jinan, China. Participants were allocated into three groups: Esketamine (E) group (n = 447), Propofol (P) group (n = 411), and Sevoflurane (S) group (n = 438). Baseline characteristics, anesthetic efficacy (including anesthesia induction time, emergence time, emergence agitation, duration of emergence agitation, and crying), and adverse reactions were compared among groups.

The three groups were well-balanced in baseline characteristics, with mean age of (6.9 ± 2.8) years and mean body weight of (21.35 ± 8.24) kg. Significant differences were observed in anesthesia induction time [(45.73 ± 9.59) s, (50.36 ± 10.28) s, and (35.53 ± 8.76) s in E, P, and S groups respectively; F = 114.05, P < 0.001] and emergence time [(21.27 ± 4.63) min, (25.34 ± 5.18) min, and (15.42 ± 4.85) min; F = 134.65, P < 0.001]. The incidences of emergence agitation (χ² = 10.09) and crying (χ² = 13.42) showed differences among groups (P < 0.05). Regarding safety profiles, significant intergroup differences were observed in incidences of hypotension (χ² = 15.85), excessive sedation (χ² = 12.65), respiratory depression (χ² = 19.83), and pain (χ² = 9.83) (all P < 0.05).

Esketamine induces effective anesthesia with mild adverse effects in children undergoing surgery.