Abstract:Objective To evaluate the effects and safety of esketamine combined with remimazolam in painless gastroscopy in obese patients. Methods A total of 138 obese patients who received elective painless gastroscopy at the Fourth Affiliated Hospital of Nanjing Medical University and Nanjing First Hospital from January to December 2022 were selected and randomly divided into group S (esketamine+remimazolam, n=69) and group C (propofol+remifentanil, n=69) by random number table method. The incidence of intraoperative hypoxemia, anesthesia induction time, test time, post-anesthesia care unit (PACU) monitoring time, and physician satisfaction were compared between two groups. The mean arterial pressure (MAP) and heart rate (HR) of two groups of patients before anesthesia (T₀), at endoscopy insertion (T₁), and at endoscopy retraction (T₂) were recorded, and the incidence of adverse events were recorded. Results The incidence of hypoxemia in group S was significantly lower than that in group C 〖JP+1〗［34.78%(24/69) vs 56.52%(39/69)， χ²=6.571， P=0.010］. The induction time for anesthesia in group S was shorter than that in group C［(23.17±2.57) s vs (24.71±2.12) s， t=3.840， P＜0.01］. Compared with group C, the PACU monitoring time of group S was significantly shorter［(14.74±1.46) s vs (17.06±1.87) s, t=8.123， P＜0.01］,〖JP+2〗 and the satisfaction of〖JP〗 〖LM〗gastroenterologists［89.86%〖JP〗(62/69) vs 75.36%(52/69), χ²=5.044， P=0.025］ and satisfaction of anesthesiologists［92.75%(64/69) vs 71.01%(49/69), χ²=10.991， P=0.001］ was significantly higher. At T₁, MAP in Group C decreased compared to group S, while HR increased compared to group S (P＜0.05). Nausea and vomiting occurred in 9 patients in group C and 5 patients in group S, and no other adverse event occurred. Conclusion Compared with propofol combined with remifentanil, remimazolam combined with eszketamine for painless gastroscopy in obese patients can reduce the incidence of hypoxemia and has higher safety.