To observe the clinical efficacy and safety of different doses of esketamine injection combined with sevoflurane inhalation in the treatment of children undergoing laparoscopic surgery.

The elective laparoscopic surgery children with general anesthesia were randomly divided into control group and treatment -L, -H groups. Three groups received anesthesia induction with 2%-3% sevoflurane + 2-3 μg·kg^-1 fentanyl + 0.15 mg·kg^-1 remimazolam. Five minutes before the start of the surgery, the treatment -L group was administered 0.25 mg·kg^-1 esketamine + 2%-3% sevoflurane for anesthesia maintenance, the treatment -H group received 0.50 mg·kg^-1 esketamine + 2%-3% sevoflurane for anesthesia maintenance, the control group was given an equal volume of 0.9% NaCl + 2%-3% sevofluran for anesthesia maintenance, sevoflurane inhalation was stopped 10 minutes before the end of the surgery. The pediatric anesthesia emergence delirium (PAED) score at the time of entering the post-anesthesia care unit (PACU), face, legs, activity, cry, consolability (FLACC) score at 6 h after surgery, wakefulness time and safety were compared among three groups.

Treatment -L group was enrolled 94 cases, 5 cases dropped out, and 89 cases were finally included in the statistical analysis; treatment -H group was enrolled 94 cases, 1 case dropped out, and 93 cases were finally included in the statistical analysis; control group was enrolled 88 cases, 2 cases dropped out, and 86 cases were finally included in the statistical analysis. The PAED scores at the time of entering the PACU in treatment -L, -H groups and control group were (9.15±1.30), (7.03±1.24) and (12.45±1.43) points; the FLACC scores at 6 h after surgery were (1.54±0.58), (1.22±0.51) and (2.26±0.64) points; the wakefulness time was (10.84±2.25), (15.92±2.62) and (10.56±2.19) min, respectively; the differences of above indexes were statistically significant between the treatment -L and control groups and the treatment -H group (all P<0.05). The adverse drug reactions of treatment -L and treatment-H groups were drowsiness and tachycardia, while those in the control group were experienced laryngospasm, respiratory depression and tachycardia. The incidences of total adverse drug reactions in treatment -L, treatment -H and control groups were 7.87%, 8.60% and 8.14%, respectively, without significant differences (all P>0.05).

Esketamine injection combined with sevoflurane inhalation can help to maintain children’s hemodynamic stability undergoing laparoscopic surgery, the dose of 0.25 mg·kg^-1·h^-1 of esketamine can improve analgesia efficacy without prolonging the recovery time and increasing the incidence of adverse drug reactions.