{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:01:36Z","timestamp":1789970496879,"version":"4.0.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Propofol-based sedation is widely used for gastrointestinal endoscopic procedures because of its rapid onset and recovery profile. However, adjunct agents are required to improve procedural tolerance and reduce propofol-related cardiorespiratory adverse effects. Ketamine and fentanyl are among the most commonly combined agents, but their comparative performance in gastrointestinal endoscopy remains unclear. This review compared propofol-ketamine with propofol-fentanyl for sedation during gastrointestinal endoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic search of major electronic databases was conducted from inception to March 2026. Study selection, data extraction, and risk-of-bias assessment were performed independently by reviewers using standard methodologies. Due to substantial heterogeneity in study population, procedure, sedation protocol, and outcome definition, findings were synthesized narratively. Outcomes of interest included additional propofol requirement, oxygen desaturation, total propofol dose, systolic blood pressure, mean arterial pressure, and time to recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>21 studies were included. Across included studies, propofol-ketamine required fewer supplemental propofol doses and lower overall propofol consumption than propofol-fentanyl. Oxygen desaturation tended to occur less frequently with propofol-ketamine in most studies, although definition varied. Hemodynamic outcomes favoured propofol-ketamine, with better control of systolic blood pressure and mean arterial pressure. Recovery findings were less consistent as several studies suggested longer recovery with ketamine-containing regimens, whereas other studies found no difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Propofol-ketamine might provide better respiratory and hemodynamic stability and propofol-sparing effect compared with propofol-fentanyl during gastrointestinal endoscopy, although recovery may be slower in fewer settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1946236","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:32:58Z","timestamp":1789968778000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of propofol fentanyl versus propofol ketamine for painless gastrointestinal endoscopy: a systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Sheng","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Wuhou District People\u2019s Hospital of Chengdu","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Wuhou District People\u2019s Hospital of Chengdu","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology Department, West China Hospital of Stomatology, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qifu","family":"He","sequence":"additional","affiliation":[{"name":"Department of Science and Education Section, Wuhou District People\u2019s Hospital of Chengdu","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1136\/gutjnl-2023-330396","article-title":"British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy","volume":"73","author":"Sidhu","year":"2024","journal-title":"Gut"},{"key":"B2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12876-020-01561-z","article-title":"Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations","volume":"21","author":"Dossa","year":"2021","journal-title":"BMC Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"106604","DOI":"10.4253\/wjge.v17.i6.106604","article-title":"Sedation in endoscopy: current practices and future innovations","volume":"17","author":"Bruni","year":"2025","journal-title":"World J Gastrointest Endosc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"6583","DOI":"10.3390\/jcm14186583","article-title":"Current and emerging sedation practices for colonoscopy: a narrative review of pharmacological agents, high-risk populations, and safety considerations","volume":"14","author":"Chudzi\u0144ski","year":"2025","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.bja.2024.07.036","article-title":"Procedural sedation competencies: a review and multidisciplinary international consensus statement on knowledge, skills, training, and credentialing","volume":"134","author":"Leroy","year":"2025","journal-title":"Br J Anaesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"844561","DOI":"10.1016\/j.bjane.2024.844561","article-title":"Comparison of propofol-ketamine and propofol-fentanyl combinations for sedation in patients undergoing gastrointestinal endoscopy: a randomized clinical trial","volume":"75","author":"Falc\u00e3o","year":"2025","journal-title":"Braz J Anesthesiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.bja.2023.11.050","article-title":"Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials","volume":"132","author":"Sharif","year":"2024","journal-title":"Br J Anaesth"},{"key":"B8","doi-asserted-by":"publisher","first-page":"423","DOI":"10.4103\/sja.sja_488_22","article-title":"Ketamine as the main analgesic agent during analgesia-based sedation for elective colonoscopy - a randomised, double-blind, control study","volume":"16","author":"Kova\u010devi\u0107","year":"2022","journal-title":"Saudi J Anaesth"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e944116","DOI":"10.12659\/MSM.944116","article-title":"Comparison of fentanyl, ketamine, and lidocaine combined with propofol anesthesia in patients with Crohn disease undergoing colonoscopy","volume":"30","author":"Chudzi\u0144ski","year":"2024","journal-title":"Med Sci Monit"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1007\/s11739-024-03697-2","article-title":"Safety of procedural sedation in emergency department settings among the adult population: a systematic review and meta-analysis of adverse events","volume":"19","author":"Khan","year":"2024","journal-title":"Intern Emerg Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Br Med J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Br Med J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Br Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"Br Med J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.bj.2015.11.002","article-title":"A comparison between the effects of propofol-fentanyl with propofolketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room","volume":"39","author":"Akhondzadeh","year":"2016","journal-title":"Biomed J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1097\/MPG.0000000000000722","article-title":"Propofol-ketamine and propofol-fentanyl combinations for nonanesthetist-administered sedation","volume":"60","author":"Chandar","year":"2015","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.4103\/njcp.njcp_1953_21","article-title":"Comparison of propofol-fentanyl and propofol-ketamine for sedoanalgesia in percutaneous endoscopic astrostomy procedures","volume":"25","author":"Duran","year":"2022","journal-title":"Niger J Clin Pract"},{"key":"B18","doi-asserted-by":"publisher","first-page":"344","DOI":"10.4103\/JCMRP.JCMRP_58_19","article-title":"A comparative study between propofol-ketamine and propofol-fentanyl for sedation during pediatric diagnostic upper gastrointestinal endoscopy","volume":"4","author":"Gad EL-Rab","year":"2019","journal-title":"J Curr Med Res Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e39835","DOI":"10.5812\/aapm.39835","article-title":"Sedative and analgesic effects of propofol-fentanyl versus propofol-ketamine during endoscopic retrograde cholangiopancreatography: a double-blind randomized clinical trial","volume":"6","author":"Gorji","year":"2016","journal-title":"Anaesth Pain Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.egja.2013.02.009","article-title":"Ketamine\/propofol versus fentanyl\/ propofol for sedating obese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)","volume":"29","author":"Hasanein","year":"2013","journal-title":"Egypt J Anaesth"},{"key":"B21","first-page":"558","article-title":"Fentanylpropofol versus ketamine-propofol combination for sedation and recovery in ERCP: a double-blinded randomized clinical trial","volume":"17","author":"Javaid","year":"2023","journal-title":"Pak J Med Sci"},{"key":"B22","first-page":"12","article-title":"Propofol-ketamine vs. propofol-fentanyl for sedation during gastrointestinal endoscopy","volume":"10","author":"Kamel","year":"2019","journal-title":"J Anesth Clin Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"208","DOI":"10.5812\/aapm.9653","article-title":"Conscious sedation and analgesia in colonoscopy: ketamine\/propofol combination has superior patient satisfaction versus fentanyl\/propofol","volume":"3","author":"Khajavi","year":"2013","journal-title":"Anesth Pain Med"},{"key":"B24","first-page":"829","article-title":"Sedative and analgesic effects of propofol-fentanyl versus propofol-ketamine during endoscopic retrograde cholangiopancreatography","volume":"17","author":"Kumar","year":"2025","journal-title":"Int J Curr Pharm Rev Res"},{"key":"B25","first-page":"37","article-title":"Efficacy of sedation for colonoscopy, a comparison between propofol and ketamine combination (ketofol) versus propofol and fentanyl combination (fenofol)","volume":"46","author":"Pathanon","year":"2021","journal-title":"J Dep Med Serv"},{"key":"B26","doi-asserted-by":"publisher","first-page":"155","DOI":"10.4103\/BJOA.BJOA_6_19","article-title":"Comparison of combination of ketamine hydrochloride and propofol with fentanyl citrate and propofol for patients undergoing endoscopic retrograde cholangiopancreatography","volume":"3","author":"Prem","year":"2019","journal-title":"Bali J Anesthesiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"14","DOI":"10.33545\/26643766.2023.v6.i2a.389","article-title":"To compare the efficacy of propofol with ketamine versus propofol with fentanyl for procedural sedation for patients undergoing endoscopic retrograde cholangiopancreatography","volume":"6","author":"Reddy","year":"2023","journal-title":"Int J Med Anesthesiol"},{"key":"B28","first-page":"388","article-title":"Comparison of ketamine-propofol and fentanyl-propofol on intraoperative hemodynamic stability in endoscopic procedures","volume":"14","author":"Safadi","year":"2025","journal-title":"J Neonatal Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"20","DOI":"10.2174\/1574886314666190726154238","article-title":"Evaluation of different sedatives for colonoscopy","volume":"15","author":"Seleem","year":"2020","journal-title":"Curr Drug Saf"},{"key":"B30","doi-asserted-by":"publisher","first-page":"43","DOI":"10.4097\/kjae.2018.71.1.43","article-title":"Comparison of propofol alone and in combination with ketamine or fentanyl for sedation in endoscopic ultrasonography","volume":"71","author":"Singh","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"B31","first-page":"222","article-title":"Comparison of propofol-ketamine vs propofol-fentanyl for pediatric sedation during upper gastrointestinal endoscopy","volume":"2","author":"Takzare","year":"2016","journal-title":"Arch Anesthesiol Crit Care"},{"key":"B32","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1111\/j.1460-9592.2007.02206.x","article-title":"Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy","volume":"17","author":"Tosun","year":"2007","journal-title":"Pediatr Anesth"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.gie.2012.03.001","article-title":"Multisociety sedation curriculum for gastrointestinal endoscopy","volume":"76","author":"Vargo","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"B34","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1055\/s-0030-1255728","article-title":"European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates guideline: non-anesthesiologist administration of propofol for GI endoscopy","volume":"42","author":"Dumonceau","year":"2010","journal-title":"Endoscopy"},{"key":"B35","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1016\/j.ajem.2007.12.005","article-title":"Adverse events associated with ketamine for procedural sedation","volume":"26","author":"Strayer","year":"2008","journal-title":"J Emerg Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.annemergmed.2010.11.030","article-title":"Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update","volume":"57","author":"Green","year":"2011","journal-title":"Ann Emerg Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/1471-230X-12-164","article-title":"Comparison between the recovery time of alfentanil and fentanyl in balanced propofol sedation for gastrointestinal and colonoscopy: a prospective, randomized study","volume":"12","author":"Ho","year":"2012","journal-title":"BMC Gastroenterol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/SLE.0000000000000532","article-title":"The comparison of midazolam and propofol in gastrointestinal endoscopy: a systematic review and meta-analysis","volume":"28","author":"Zhang","year":"2018","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"B39","doi-asserted-by":"publisher","first-page":"107515","DOI":"10.1016\/j.drugalcdep.2019.06.017","article-title":"Fentanyl exposure and preferences among individuals starting treatment for opioid use disorder","volume":"204","author":"Gryczynski","year":"2019","journal-title":"Drug Alcohol Depend"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1662057","DOI":"10.3389\/fphar.2025.1662057","article-title":"Adjunctive esketamine in propofol-based sedation for gastrointestinal endoscopy: a systematic review and meta-analysis of randomized trials","volume":"16","author":"Qi","year":"2025","journal-title":"Front Pharmacol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.ajem.2015.12.074","article-title":"Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis","volume":"34","author":"Jalili","year":"2016","journal-title":"Am J Emerg Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1111\/acem.12737","article-title":"Ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis","volume":"22","author":"Yan","year":"2015","journal-title":"Acad Emerg Med"},{"key":"B43","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/978-1-0716-4603-8_24","article-title":"Procedural sedation and analgesia with spontaneous ventilation outside the operating room in non-emergency scenarios and ketamine","volume-title":"Ketamine: From Neurobiology to Emergency and Anesthesia Care, Volume I","author":"Sarkar","year":"2025"},{"key":"B44","doi-asserted-by":"publisher","first-page":"103","DOI":"10.3390\/ecm1020014","article-title":"Procedural sedation in emergency department: a narrative review","volume":"1","author":"Cappellini","year":"2024","journal-title":"Emerg Care Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/bja\/aer221","article-title":"Ketamine: new uses for an old drug?","volume":"107","author":"Hirota","year":"2011","journal-title":"Br J Anaesth"},{"key":"B46","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1097\/00000542-199205000-00010","article-title":"Sympathetic responses to induction of anesthesia in humans with propofol or etomidate","volume":"76","author":"Ebert","year":"1992","journal-title":"Anesthesiology"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1007\/s40262-018-0672-3","article-title":"Clinical pharmacokinetics and pharmacodynamics of propofol: MM Sahinovic et al","volume":"57","author":"Sahinovic","year":"2018","journal-title":"Clin Pharmacokinet"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1946236\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:33:00Z","timestamp":1789968780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1946236\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":47,"alternative-id":["10.3389\/fmed.2026.1946236"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1946236","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"1946236"}}