Effectiveness of ketamine-propofol sedation for reducing respiratory adverse events compared to propofol sedation: A Meta-Analysis of randomized controlled trials

Objective: The objective of our review was to determine whether ketamine-propofol had an advantage in reducing respiratory adverse events compared to propofol for procedural sedation. Methods: Electronic databases including Web of Science, The Cochrane Library, PubMed, Medline, Embase, Google Scholar were searched to identify potential studies. All randomized controlled studies from their inception to May 2020 comparing ketamine-propofol sedation with propofol sedation were identified. Pooled analysis and subgroup analysis were conducted using Stata software. The quality assessment of all included studies was completed by using the Cochrane Collaboration's tool for assessing risk of bias. Results: A total of 21 studies involving 3669 individuals were included. The most common respiratory adverse events (all reported per 100 sedations) were: hypoxia(KP 10.9%; P 17.0%), respiratory depression(KP 6.9%; P 14.9%), central apnea(KP 5.9%; P 8.0%). Pooling these 21 studies, subjects with ketamine-propofol had significant lower incidence of respiratory adverse events than those with propofol (RR: 0.55, 95% CI: 0.41–0.74). When stratified by study population, no significant difference was observed in reducing respiratory adverse events between ketamine-propofol sedation and propofol sedation among children (RR: 0.74, 95% CI: 0.46–1.20). However, significant differences were discerned definitely among adults(RR: 0.48, 95% CI: 0.39–0.60). Conclusion: In summary, Our results suggested hypoxia, respiratory depression, central apnea were most common respiratory adverse events in propofol sedation. However, ketamine-propofol sedation had an advantage in reducing the incidence of respiratory adverse events compared with propofol sedation, especially in adults.