To analyze the efficacy and safety of different doses of esketamine for laparoscopic high hernia sac ligation in school-age children.

The school-age children who underwent laparoscopic high ligation of hernia sac were divided into small-dose group and conventional-dose group according to cohort method. The conventional-dose group was given intravenous 0.75 mg·kg^-1 esketamine hydrochloride injection to prepare for induction; the small-dose group was given intravenous 0.50 mg·kg^-1 esketamine hydrochloride injection to prepare for induction, and the two groups were given the same anesthesia induction, anesthesia maintenance and postoperative analgesia. The recovery time, laryngeal mask removal time, anesthesia recovery room residence time, children face, legs, activity, cry, consolability behavioral tool (FLACC) score of the children in the two groups were observed, the hemodynamic indexes were recorded at the time of entry (T1), before anesthesia induction (T2), immediately after laryngeal mask placement (T3), and the safety was evaluated.

A total of 39 cases and 43 cases children were included in the conventional-dose group and the small-dose group, respectively. After treatment, the recovery time of conventional-dose group and small-dose group were (26.36±3.91) and (23.21±3.55) min; the time of removing laryngeal mask were (13.02±2.15) and (12.24±2.30) min; the retention time of postanesthesia care unit (PACU) were (37.23±5.64) and (32.11±5.36) min; the scores of FLACC were (2.08±0.45) and (2.16±0.51) points, respectively. At T1, T2 and T3, the heart rate (HR) of the conventional-dose group were (99.23±15.78), (102.19±17.20) and (118.30±14.96) beat·min^-1; that of the small-dose group were (99.93±16.27), (103.28±16.75) and (120.19±15.39) beat·min^-1, respectively. The mean arterial pressure (MAP) of the conventional-dose group were (84.56±7.22), (85.92±6.96) and (89.89±7.02) mmHg; that of the small-dose group were (84.88±6.87), (86.16±6.45) and (91.12±7.31) mmHg, respectively. There were statistically significant differences in the recovery time and PACU retention time between the small-dose group and the conventional-dose group (all P<0.05). The adverse drug reactions in the two groups mainly included nausea and vomiting, increased secretions and transient hypertension. The incidence of total adverse drug reactions in the conventional-dose group and the small-dose group were 10.26% and 4.65%, respectively, with no statistical significance (P>0.05).

Small-dose esketamine hydrochloride injection can effectively maintain hemodynamic stability in the preoperative intravenous administration of school-age children undergoing laparoscopic high ligation of hernia sac, and the effect of reducing postoperative pain and inhibiting agitation during the recovery period is comparable to that of conventional-dose, with good safety.