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. 2025 Jul-Sep;19(3):292-302.
doi: 10.4103/sja.sja_588_24. Epub 2025 Jun 16.

Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis

Elliott N Rees  1 , Lucy Ms Hoade  2 , Luke Mattey  3
Affiliations

Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis

Elliott N Rees et al. Saudi J Anaesth. 2025 Jul-Sep.

Abstract

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.

Keywords: Analgesia; endoscopy; sedation.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flow diagram representing the search and screening process of articles included in review
Figure 2
Figure 2
Risk-of-bias summary and graph showing authors’ judgments regarding each risk-of-bias domain
Figure 3
Figure 3
Results of meta-analysis for the following outcomes: (a) procedure time, (b) recovery time, (c) apnea, (d) bradycardia, (e) desaturation, (f) hallucinations, (g) hypertension, (h) hypotension, (i) nausea, (j) tachycardia
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