{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:56:53Z","timestamp":1789145813742,"version":"build-2803163510"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Findings:<\/jats:title>\n \n 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);\n P<\/jats:italic>\n < 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);\n P<\/jats:italic>\n < 0.01) and hypotension (PF: 17.20% vs PK: 8.33%, OR = 2.501 (95% CI, 1.296, 4.824);\n P<\/jats:italic>\n < 0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/sja.sja_588_24","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T01:00:19Z","timestamp":1750035619000},"page":"292-302","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Propofol-Fentanyl versus propofol-ketamine sedation in gastrointestinal endoscopy: A systematic review and meta-analysis"],"prefix":"10.4103","volume":"19","author":[{"given":"Elliott N.","family":"Rees","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Morriston Hospital, Swansea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy MS","family":"Hoade","sequence":"additional","affiliation":[{"name":"School of Surgery, Health Education and Improvement Wales, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Mattey","sequence":"additional","affiliation":[{"name":"School of Medicine, Cardiff University Medical School, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"R1-20260423","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1111\/j.1572-0241.2007.01778.x","article-title":"Technical performance of colonoscopy: The key role of sedation\/analgesia and other quality indicators","volume":"103","author":"Radaelli","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"R2-20260423","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.gie.2007.12.046","article-title":"A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures","volume":"67","author":"McQuaid","year":"2008","journal-title":"Gastrointest 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control study","volume":"16","author":"Kova\u010devi\u0107","year":"2022","journal-title":"Saudi J Anaesth"},{"key":"R22-20260423","first-page":"558","article-title":"Fentanyl-propofol versus ketamine-propofol combination for sedation and recovery in ERCP: A double-blinded randomized clinical trial","volume":"17","author":"Javaid","year":"2023","journal-title":"Pakistan Journal of Medical Sciences"},{"key":"R23-20260423","doi-asserted-by":"crossref","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":"R24-20260423","doi-asserted-by":"crossref","first-page":"208","DOI":"10.5812\/aapm.9653","article-title":"Conscious sedation and analgesia in colonoscopy: Ketamine\/Propofol combination has superior patient 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