Esketamine

Prior use of esketamine as an adjunct in same-visit bidirectional endoscopy achieved a 61% reduction in desaturation and hypotension versus control. In ERCP procedures, esketamine as a propofol adjunct reduced the required propofol dose without affecting recovery time or patient satisfaction. Esketamine offers approximately twice the potency of racemic ketamine with less cardiorespiratory depression and a lower incidence of psychotropic side effects. No randomised controlled trial has yet evaluated esketamine specifically for haematologic-oncologic procedures in children. Esketamine has been studied as a propofol adjunct across multiple paediatric procedural contexts including 3-Tesla MRI, hydrostatic reduction of intussusception, and forearm fracture management.