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

Methods 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.

Results 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).

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