Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis
Background: The optimal procedural sedation and analgesic regime for gastrointestinal endoscopy is uncertain. Ketamine and fentanyl are commonly used analgesic agents alongside propofol but both have significant side effect profiles. Objectives: This systematic review and meta-analysis compares the...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-07-01
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| Series: | Saudi Journal of Anaesthesia |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/sja.sja_588_24 |
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| _version_ | 1849425705877635072 |
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| author | Elliott N. Rees Lucy MS Hoade Luke Mattey |
| author_facet | Elliott N. Rees Lucy MS Hoade Luke Mattey |
| author_sort | Elliott N. Rees |
| collection | DOAJ |
| description | Background:
The optimal procedural sedation and analgesic regime for gastrointestinal endoscopy is uncertain. Ketamine and fentanyl are commonly used analgesic agents alongside propofol but both have significant side effect profiles.
Objectives:
This systematic review and meta-analysis compares the efficacy and safety of propofol-ketamine (PK) to propofol-fentanyl (PF) sedation for patients undergoing gastrointestinal endoscopy.
Methods:
Medline, EMBASE, and CENTRAL were searched to identify all comparative studies comparing PF to PK sedation. Nine randomized control trials (RCTs) met inclusion criteria. The primary outcomes were procedure time and recovery time. Secondary outcomes included adverse effects. All outcome data analyses were conducted using random-effects modeling.
Findings:
Nine RCTs with a total of 1006 patients were analyzed (508 (50.5%) PF, 498 PK). Sedation-analgesia regimes with PF were associated with both shorter procedure times (mean difference (MD) = -1.670 minutes (95% CI, -2.890, -0.450); P < 0.01) and recovery times (MD = -1.215 minutes (95% CI,-2.131, -0.300)) compared with PK. In the PF group, there was a higher incidence of desaturation (PF: 18.03% vs PK: 7.84%, OR = 3.163 (95% CI, 1.552, 6.444); P < 0.01) and hypotension (PF: 17.20% vs PK: 8.33%, OR = 2.501 (95% CI, 1.296, 4.824); P < 0.01).
Conclusions:
There is moderate certainty evidence that PF reduces procedure time and low certainty that it improves recovery time compared to PK for gastrointestinal endoscopy. The risk of potentially life-threatening hypotension and desaturation was significantly greater in the PF group. |
| format | Article |
| id | doaj-art-b804ef756e924ee7b4874046041bd815 |
| institution | Kabale University |
| issn | 1658-354X 0975-3125 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj-art-b804ef756e924ee7b4874046041bd8152025-08-20T03:29:40ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X0975-31252025-07-0119329230210.4103/sja.sja_588_24Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysisElliott N. ReesLucy MS HoadeLuke MatteyBackground: The optimal procedural sedation and analgesic regime for gastrointestinal endoscopy is uncertain. Ketamine and fentanyl are commonly used analgesic agents alongside propofol but both have significant side effect profiles. Objectives: This systematic review and meta-analysis compares the efficacy and safety of propofol-ketamine (PK) to propofol-fentanyl (PF) sedation for patients undergoing gastrointestinal endoscopy. Methods: Medline, EMBASE, and CENTRAL were searched to identify all comparative studies comparing PF to PK sedation. Nine randomized control trials (RCTs) met inclusion criteria. The primary outcomes were procedure time and recovery time. Secondary outcomes included adverse effects. All outcome data analyses were conducted using random-effects modeling. Findings: Nine RCTs with a total of 1006 patients were analyzed (508 (50.5%) PF, 498 PK). Sedation-analgesia regimes with PF were associated with both shorter procedure times (mean difference (MD) = -1.670 minutes (95% CI, -2.890, -0.450); P < 0.01) and recovery times (MD = -1.215 minutes (95% CI,-2.131, -0.300)) compared with PK. In the PF group, there was a higher incidence of desaturation (PF: 18.03% vs PK: 7.84%, OR = 3.163 (95% CI, 1.552, 6.444); P < 0.01) and hypotension (PF: 17.20% vs PK: 8.33%, OR = 2.501 (95% CI, 1.296, 4.824); P < 0.01). Conclusions: There is moderate certainty evidence that PF reduces procedure time and low certainty that it improves recovery time compared to PK for gastrointestinal endoscopy. The risk of potentially life-threatening hypotension and desaturation was significantly greater in the PF group.https://journals.lww.com/10.4103/sja.sja_588_24analgesiaendoscopysedation |
| spellingShingle | Elliott N. Rees Lucy MS Hoade Luke Mattey Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis Saudi Journal of Anaesthesia analgesia endoscopy sedation |
| title | Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis |
| title_full | Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis |
| title_fullStr | Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis |
| title_full_unstemmed | Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis |
| title_short | Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis |
| title_sort | propofol fentanyl versus propofol ketamine sedation in gastrointestinal endoscopy a systematic review and meta analysis |
| topic | analgesia endoscopy sedation |
| url | https://journals.lww.com/10.4103/sja.sja_588_24 |
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