Comparison of propofol fentanyl versus propofol ketamine for painless gastrointestinal endoscopy: a systematic review

Abstract

Background Propofol-based sedation is widely used for gastrointestinal endoscopic procedures because of its rapid onset and recovery profile. However, adjunct agents are required to improve procedural tolerance and reduce propofol-related cardiorespiratory adverse effects. Ketamine and fentanyl are among the most commonly combined agents, but their comparative performance in gastrointestinal endoscopy remains unclear. This review compared propofol-ketamine with propofol-fentanyl for sedation during gastrointestinal endoscopy. Methods Systematic search of major electronic databases was conducted from inception to March 2026. Study selection, data extraction, and risk-of-bias assessment were performed independently by reviewers using standard methodologies. Due to substantial heterogeneity in study population, procedure, sedation protocol, and outcome definition, findings were synthesized narratively. Outcomes of interest included additional propofol requirement, oxygen desaturation, total propofol dose, systolic blood pressure, mean arterial pressure, and time to recovery. Results 21 studies were included. Across included studies, propofol-ketamine required fewer supplemental propofol doses and lower overall propofol consumption than propofol-fentanyl. Oxygen desaturation tended to occur less frequently with propofol-ketamine in most studies, although definition varied. Hemodynamic outcomes favoured propofol-ketamine, with better control of systolic blood pressure and mean arterial pressure. Recovery findings were less consistent as several studies suggested longer recovery with ketamine-containing regimens, whereas other studies found no difference. Conclusion Propofol-ketamine might provide better respiratory and hemodynamic stability and propofol-sparing effect compared with propofol-fentanyl during gastrointestinal endoscopy, although recovery may be slower in fewer settings.