Postoperative fatigue is common after colonoscopy, linked to bowel preparation and the procedure itself. In a randomized trial, 151 patients received either low-dose esketamine (0.15 mg/kg) or sufentanil (0.1 μg/kg) before anesthesia. Esketamine reduced the incidence of postoperative fatigue from 44% to 28% at 30 minutes after the procedure, and shortened discharge time from 30 to 25 minutes. Hemodynamic stability and patient satisfaction were also better with esketamine. The findings suggest that adding esketamine to propofol anesthesia is an effective strategy for painless colonoscopy.
Intensivists at a tertiary academic ICU felt ongoing discomfort using ketamine for analgosedation, even after a large increase in its use during the COVID-19 pandemic. Among 446 mechanically ventilated medical ICU patients, ketamine prescriptions rose from 4 (2.1%) pre-COVID to 81 (32.3%) during the COVID-19 surge. Focus groups with 13 attending intensivists revealed three key themes behind their discomfort: a lack of evidence about ketamine, a lack of personal experience, and a desire for more education and protocols. The increase in hands-on experience alone did not reduce provider discomfort, suggesting that continuing education and process improvements are needed to support adoption of unfamiliar therapies.