Purpose of Review

The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients.

Methods

We searched PubMed, CENTRAL, Web of Science, and Scopus from inception to August 1, 2023. Our outcome parameters for efficacy were recovery time, pain score, and physician satisfaction while for safety were the related cardiorespiratory, neurological, and gastrointestinal adverse events.

Recent Findings

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; I² = 94%) and a significantly less pain score of − 0.72 (95% CI, − 1.10, − 0.34; I² = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I² = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I² = 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; I² = 15%).

Summary

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.

中文翻译：

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氯胺酮-右美托咪定与氯胺酮-丙泊酚组合围手术期镇静的功效和安全性：系统评价和荟萃分析

审查目的

氯胺酮与丙泊酚和右美托咪定的组合在不同人群的镇静和全身麻醉中广受欢迎。在我们的荟萃分析中，我们帮助麻醉师了解两种组合在成人和儿童患者中的效率和功效。

方法

我们检索了 PubMed、CENTRAL、Web of Science 和 Scopus，从开始到 2023 年 8 月 1 日。我们的疗效结局参数是恢复时间、疼痛评分和医生满意度，而安全性结局参数是相关的心肺、神经和胃肠道不良事件。

最近的发现

共纳入 22 项试验，共 1429 名患者。我们发现 ketadex 组的恢复时间显着延长，为 7.59 分钟（95% CI，4.92，10.26；I ²  = 94%），疼痛评分显着降低，为 − 0.72（95% CI，− 1.10，− 0.34；I ²  = 0%）。成人对酮福尔组的医生满意度评分明显更高，比值比为 0.29（95% CI，0.12，0.71；I ²  = 0%）。酮酚组的恢复期躁动较高，优势比为 0.48（95% CI，0.24，0.98；I ²  = 36%）。此外，我们发现 ketadex 组中发病率较高的组合之间存在显着差异，合并比值比为 1.75（95% CI，1.06，2.88；I ²  = 15%）。

概括

Ketadex 与较低的疼痛评分、缺氧事件、气道阻塞以及苏醒期躁动相关。同时，酮福酚的临床医生满意度更高，这可能是由于其恢复时间更短，恶心和呕吐的发生率更低。因此，我们认为对于术后恶心和呕吐风险不较高的成人和儿童患者来说，Ketadex 是围手术期镇静的更好组合。