Evaluating the combination of esketamine and propofol in procedural analgesia/sedation: a systematic review and meta-analysis

Procedural sedation and analgesia (PSA) ensure patient comfort during invasive procedures. While propofol is widely used, its risks include hypotension and bradycardia. Combining it with esketamine may improve sedation and reduce side effects. This meta-analysis evaluates the safety and efficacy of esketamine-propofol combinations compared to alternative PSA regimens. A systematic search was conducted across PubMed, Cochrane Central, and Google Scholar, identifying 20 studies involving 2023 patients. These studies compared esketamine-propofol combinations with other PSA regimens. Statistical analyses were performed via Review Manager 5.4 using the Mantel-Haenszel and inverse variance models, with heterogeneity assessed using the Higgins I2 statistic. Sensitivity and subgroup analyses were performed to address significant heterogeneity. The esketamine-propofol combination significantly reduced the risk of bradycardia (RR: 0.42, 95% CI 0.25-0.71, P=0.001) and hypotension (RR: 0.40, 95% CI 0.30-0.53, P<0.01). Propofol consumption was markedly lower in the intervention group (std MD: -1.86, 95% CI -2.53 to -1.18, P<0.01), and so was the injection pain (RR: 0.36, 95% CI 0.19-0.70, P=0.003). The risk of respiratory depression also decreased remarkably compared to the control (RR: 0.32, 95% CI 0.16-0.64, P=0.001). However, no significant differences in the recovery time and the incidence of nausea, vomiting, and tachycardia were observed. The esketamine-propofol combination offers a safer and more effective PSA regimen, minimizing cardiovascular and respiratory complications while enhancing analgesia and reducing the need for higher propofol doses.