SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Experimental Pharmacology and Drug Discovery
This article is part of the Research TopicAdvances in Novel Pharmacotherapeutics and Drug Discovery: Computational, Experimental, Translational, and Clinical Models, Volume IIView all 11 articles
Adjunctive Esketamine in Propofol‑Based Sedation for Gastrointestinal Endoscopy: A systematic review and meta-analysis of randomized trials
Provisionally accepted
- 1Huashan Hospital Fudan University, Shanghai, China
- 2The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- 3The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Background: While propofol is widely used for gastrointestinal endoscopic sedation, its cardiovascular and respiratory side effects and lack of analgesia can compromise safety and comfort. Esketamine provides both sedation and analgesia with minimal hemodynamic or respiratory impact. Combining esketamine with propofol may mitigate propofol's adverse effects while enhancing sedation quality. However, the combination's overall safety and efficacy remain inconclusive. Methods: This systematic review and meta-analysis compared propofol-based sedation with versus without intravenous esketamine in gastrointestinal endoscopy, synthesizing evidence from randomized controlled trials. The primary outcome was the incidence of hypotension. Secondary outcomes included intraoperative adverse respiratory events, propofol consumption, involuntary movement, hypertension, arrhythmias, PONV recovery times, and dizziness. Results: Eighteen trials were included in the analysis. Additional esketamine significantly reduced the incidence of hypotension (risk ratio [RR]: 0.32; 95% confidence interval [CI]: 0.24 to 0.43; P < 0.01; I² = 44.4%; moderate quality). The addition of esketamine to propofol can reduce the incidence of adverse respiratory events (RR: 0.57, 95% CI: 0.38 to 0.86; P < 0.01; I² = 67.8%; moderate quality). Esketamine added to propofol decreased involuntary movement (RR: 0.61, 95% CI: 0.42 to 0.92; P=0.02; I² = 77.2%; low quality) and reduced the propofol consumption (mean difference [MD]: -0.94, 95% CI: -1.53 to -0.35 mg/kg; P < 0.01; I² = 96.2%; low quality). No significant differences were found for hypertension, arrhythmias, PONV, recovery time or dizziness. Conclusions: Supplementing propofol‑based sedation with esketamine reduced the risk of hypotension and adverse respiratory events, without increasing cardiovascular complications, or extending recovery‑time.
Keywords: Esketamine, gastrointestinal endoscopy, hemodynamic, Propofol, Adverse respiratory events, Dizziness
Received: 08 Jul 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Qi, Luo, Zong, Zhang, Chen, Yang, Xu and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bo Xu, xubo-mazui@163.com
Xu Zhao, zhaox263@mail.sysu.edu.cn
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