Rees Elliott N, Hoade Lucy Ms, Mattey Luke
Department of Intensive Care, Morriston Hospital, Swansea, UK.
School of Surgery, Health Education and Improvement Wales, Cardiff, UK.
Saudi J Anaesth. 2025 Jul-Sep;19(3):292-302. doi: 10.4103/sja.sja_588_24. Epub 2025 Jun 16.
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.
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.
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.
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); < 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); < 0.01) and hypotension (PF: 17.20% vs PK: 8.33%, OR = 2.501 (95% CI, 1.296, 4.824); < 0.01).
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.
用于胃肠内镜检查的最佳程序镇静和镇痛方案尚不确定。氯胺酮和芬太尼是与丙泊酚一起常用的镇痛剂，但两者都有明显的副作用。
本系统评价和荟萃分析比较了丙泊酚-氯胺酮（PK）与丙泊酚-芬太尼（PF）镇静用于接受胃肠内镜检查患者的疗效和安全性。
检索了Medline、EMBASE和CENTRAL以识别所有比较PF与PK镇静的对照研究。9项随机对照试验（RCT）符合纳入标准。主要结局是操作时间和恢复时间。次要结局包括不良反应。所有结局数据分析均采用随机效应模型。
分析了9项RCT，共1006例患者（508例（50.5%）PF，498例PK）。与PK相比，PF镇静镇痛方案的操作时间（平均差（MD）=-1.670分钟（95%CI，-2.890，-0.450）；P<0.01）和恢复时间（MD=-1.215分钟（95%CI，-2.131，-0.300））均较短。在PF组，低氧血症发生率较高（PF：18.03% vs PK：7.84%，OR=3.163（95%CI，1.552，6.444）；P<0.01）和低血压发生率较高（PF：17.20% vs PK：8.33%，OR=2.501（95%CI，1.296，4.824）；P<0.01）。
有中等确定性证据表明，与PK相比，PF可缩短胃肠内镜检查的操作时间，且低确定性证据表明其可改善恢复时间。PF组潜在危及生命的低血压和低氧血症风险显著更高。
