Adjunctive esketamine in propofol-based sedation for gastrointestinal endoscopy: a systematic review and meta-analysis of randomized trials.

Summary

Across 18 randomized trials, adjunctive esketamine with propofol significantly reduced hypotension (RR 0.32) and respiratory adverse events, without prolonging recovery or increasing cardiovascular complications.

Key Findings

• Eighteen randomized trials were included with PROSPERO registration of the review.
• Adjunctive esketamine reduced hypotension risk (RR 0.32; 95% CI 0.24–0.43).
• Respiratory adverse events decreased with esketamine adjunct without prolonging recovery time.
• No increase in cardiovascular complications was observed.

Clinical Implications

Consider low-dose esketamine adjunct during GI endoscopy sedation to reduce hypotension and hypoxemia, especially in high-risk patients; develop dosing algorithms integrated into ERAS and monitored anesthesia care.

Limitations

• Heterogeneity in dosing regimens and sedation protocols not fully detailed in abstract
• Patient-level moderators and long-term outcomes were not reported

Future Directions

Define optimal esketamine dosing strategies with patient-level meta-analyses; evaluate cognitive recovery and delirium risk; extend to non-GI procedural sedation.