review · Current Pain and Headache Reports
A systematic review and meta-analysis evaluating twenty-two trials with 1,429 patients compared ketamine combined with dexmedetomidine against ketamine combined with propofol for periprocedural sedation. The findings show that the ketamine-dexmedetomidine combination resulted in significantly lower pain scores, fewer hypoxic events, less airway obstruction, and reduced emergence agitation. However, patients receiving this combination experienced a recovery time that was roughly seven and a half minutes longer, alongside a higher incidence of nausea and vomiting. Conversely, the ketamine-propofol combination was linked to higher clinician satisfaction in adult patients, likely driven by quicker patient recovery and fewer emetic complications. Overall, the evidence indicates ketamine-dexmedetomidine provides superior clinical outcomes for both adult and paediatric patients, provided they are not at elevated risk of postoperative nausea and vomiting.
Choosing the right sedative combination is critical for patient safety and procedural success. These findings clarify the clinical trade-offs between two widely used drug mixtures. By demonstrating that ketamine and dexmedetomidine reduce airway risks, hypoxia, and agitation, the analysis provides healthcare practitioners with clearer evidence to tailor sedation protocols, particularly when respiratory safety and pain control are the primary clinical priorities.
This evidence directly informs clinical protocol design, hospital procurement, and anaesthesia guidelines for periprocedural care. The primary users are anaesthetists, emergency physicians, and clinical directors managing procedural sedation in adult and paediatric units. Because both drug combinations utilise approved, commercially available pharmaceuticals evaluated in clinical trials, the findings are immediately applicable to hospital practice and formulary decision-making without requiring further technology translation steps.
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Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I<sup>2</sup> = 94%) and a significantly less pain score of - 0.72 (95% CI, - 1.10, - 0.34; I<sup>2</sup> = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I<sup>2</sup> = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I<sup>2</sup> = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I<sup>2</sup> = 15%). Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.
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DOI: 10.1007/s11916-023-01208-0
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