Safety and efficacy of the combination of esketamine and propofol in procedural sedation/analgesia: a systematic review and meta-analysis.

INTRODUCTION

This review and meta-analysis of randomized controlled trials (RCTs) assessed the side effects and efficacy of esketamine combined with propofol in procedural sedation and analgesia.

EVIDENCE ACQUISITION

The PubMed, MEDLINE, Embase and Cochrane Library databases were searched for relevant studies occurring between their inceptions and September 2022. The primary outcome was the incidence of sedation-related adverse events. Secondary outcomes included recovery time, total consumption of propofol and body movement.

EVIDENCE SYNTHESIS

Data from a total of seven RCTs enrolling 808 patients were included in the meta-analysis. Pooling of data showed that compared with other drug regimens, the esketamine and propofol combination was associated with a reduction in the risk of hypotension (relative risk [RR]: 0.37, 95% confidence interval [CI]: 0.25 to 0.56) and bradycardia (RR: 0.34, 95% CI: 0.15 to 0.80) as well as an increase in the risk of agitation (RR: 6.29, 95% CI: 1.15 to 34.32). The results also indicated a decrease in propofol consumption (standardized mean difference: -1.45, 95% CI: -2.39 to -0.50) with the use of the esketamine and propofol combination. No significant difference was observed between the two groups in respiratory depression, nausea/vomiting, recovery time or body movement.

CONCLUSIONS

Esketamine combined with propofol has an advantage in reducing the incidence of hypotension and bradycardia during procedural sedation and analgesia, but it may increase the risk of agitation in the recovery phase. More studies of high quality are needed before the widespread adoption of the combination of esketamine and propofol.