Intravenous esketamine as an adjuvant for sedation/analgesia outside the operating room: a systematic review and meta-analysis

被引:1
作者
Kan, Ziheng [1 ]
Min, Weixiang [2 ]
Dai, Yuee [2 ]
Zhang, Peng [2 ]
机构
[1] Univ Elect Sci & Technol China, Sch Med, Chengdu, Peoples R China
[2] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Sch Med, Dept Anesthesiol, Chengdu, Peoples R China
关键词
esketamine; sedation; analgesia; outside of operating room; propofol; PAINLESS GASTROSCOPY; PROCEDURAL SEDATION; DOUBLE-BLIND; PROPOFOL; KETAMINE; SAFETY; EFFICACY; DEXMEDETOMIDINE; COMBINATION; PHARMACOKINETICS;
D O I
10.3389/fphar.2024.1287761
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Background: This study was conducted to evaluate the safety and efficacy of intravenous esketamine as an adjuvant for sedation or analgesia outside the operating room in adults and children. Method: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus were searched for potential randomized controlled studies randomized controlled trials comparing drug combinations of esketamine to any other single or combination drug regimens for sedation or analgesia outside the operating room. Results: Twenty-five studies with a total of 3,455 participants were included in this review. The pooled results of adults showed that compared with drug regimens of the control group, intravenous esketamine combinations were significantly associated with decreased risk of oxygen desaturation (RR = 0.49, 95% CI = [0.34, 0.70]); hypotension (RR = 0.38, 95% CI = [0.31, 0.46]); bradycardia (RR = 0.23, 95% CI = [0.12, 0.43]); injection pain (RR = 0.37, 95% CI = [0.25, 0.53]); body movement (RR = 0.60, 95% CI = [0.41, 0.88]); and propofol consumption (SMD = -1.38, 95% CI = [-2.64, -0.11]), but an increased risk of psychiatric symptoms (RR = 3.10, 95% CI = [2.11, 4.54]) (RR = relative risk; CI = confidence intervals; SMD = standardized mean difference). Subgroup analysis showed that only the combination of esketamine and propofol significantly reduced the above incidence of respiratory and cardiovascular adverse events in adults. In addition, the pooled results of children showed that compared with drug regimens of the control group, esketamine and propofol co-administration significantly reduced the risk of hypotension (RR = 0.59, 95% CI = [0.37, 0.95]) but increased the risk of visual disturbance (RR = 6.62, 95% CI = [2.18, 20.13]) and dizziness (RR = 1.99, 95% CI = [1.17, 3,37]). Subgroup analysis indicated that esketamine>0.5 mg/kg significantly reduced the incidence of hypotension, but increased the risk of dizziness in children. Conclusion: Intravenous use of esketamine, particularly in combination with propofol, may improve the safety and efficacy of sedation and analgesia outside the operating room, although the potential for psychiatric side effects warrants attention. Future research is recommended to investigate the role of esketamine with agents other than propofol.
引用
收藏
页数:19
相关论文
共 47 条
[1]   A retrospective comparison of propofol alone to propofol in combination with dexmedetomidine for pediatric 3T MRI sedation [J].
Boriosi, Juan P. ;
Eickhoff, Jens C. ;
Klein, Kristi B. ;
Hollman, Gregory A. .
PEDIATRIC ANESTHESIA, 2017, 27 (01) :52-59
[2]   Analysis of the efficacy of subclinical doses of esketamine in combination with propofol in non-intubated general anesthesia procedures-a systematic review and meta-analysis [J].
Chen, Haoming ;
Ding, Xizhi ;
Xiang, Guilin ;
Xu, Liu ;
Liu, Qian ;
Fu, Qiang ;
Li, Peng .
BMC ANESTHESIOLOGY, 2023, 23 (01)
[3]   Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: a prospective, randomized, double-blind controlled clinical trial [J].
Chen, Jiejuan ;
Zou, Xiaohua ;
Hu, Bailong ;
Yang, Yang ;
Wang, Feng ;
Zhou, Qian ;
Shen, Minhuan .
BMC ANESTHESIOLOGY, 2022, 22 (01)
[4]   Safety and tolerability of esketamine in propofol based sedation for endoscopic variceal ligation with or without injection sclerotherapy: Randomized controlled trial [J].
Chen, Yuanjing ;
Chen, Jie ;
Wang, Quankai ;
Lyu, Hongyao ;
Chen, Xuehan ;
Liu, Rui ;
Wang, Ting ;
Dan, Ling ;
Huang, He ;
Duan, Guangyou .
DIGESTIVE ENDOSCOPY, 2023, 35 (07) :845-854
[5]   Esketamine Combined with Propofol TCI versus Propofol TCI for Deep Sedation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Prospective, Randomized, and Controlled Trial [J].
Cui, Sichen ;
Huang, Peiying ;
Wei, Zhanxiong ;
Guo, Ting ;
Zhang, Aiyan ;
Huang, Lining .
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, 2023, 2023
[6]   Low-dose ketamine or opioids combined with propofol for procedural sedation in the emergency department: a systematic review [J].
De Vries, Linda J. ;
Veeger, Nic J. G. M. ;
Van Roon, Eric N. ;
Lameijer, Heleen .
EUROPEAN JOURNAL OF EMERGENCY MEDICINE, 2023, 30 (04) :244-251
[7]   The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography A randomised controlled multicentre trial [J].
Eberl, Susanne ;
Koers, Lena ;
van Hooft, Jeanine ;
de Jong, Edwin ;
Hermanides, Jeroen ;
Hollmann, Markus W. ;
Preckel, Benedikt .
EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2020, 37 (05) :394-401
[8]   The median effective concentration of propofol in combination with different doses of esketamine during gastrointestinal endoscopy in adults [J].
Feng, Miaomiao ;
Shi, Gaoxiang ;
Cui, Wenjing ;
Zhang, Ning ;
Xie, Qipeng ;
Zhang, Weiwei .
FRONTIERS IN PHARMACOLOGY, 2022, 13
[9]   Low dose of esketamine combined with propofol in painless fibronchoscopy in elderly patients [J].
Feng, Yankun ;
Du, Tianming ;
Wang, Jafang ;
Chen, Zhijun .
MEDICINE, 2022, 101 (50)
[10]   Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis [J].
Foo, Tze Yong ;
Mohd Noor, Norhayati ;
Yazid, Mohd Boniami ;
Fauzi, Mohd Hashairi ;
Abdull Wahab, Shaik Farid ;
Ahmad, Mohammad Zikri .
BMC EMERGENCY MEDICINE, 2020, 20 (01)