A meta-analysis of randomized controlled trials: combination of ketamine and propofol versus ketamine alone for procedural sedation and analgesia in children

Although ketamine has been used for procedural sedation and analgesia, some researchers have assessed ketamine–propofol as a better alternative because of its reduced adverse events. The goal of this review was to compare adverse events between ketamine–propofol and ketamine for procedural sedation and analgesia in children. We searched the literature from their inception to May 2018 without the restriction of language. We included all randomized controlled trials comparing ketamine–propofol with ketamine for procedural sedation and analgesia in children. The meta-analysis was conducted using the Stata software. A total of six studies involving 693 individuals were included. Pooling of data showed that subjects with ketamine–propofol had similar incidence of respiratory adverse events compared to those with ketamine (RR 1.16, 95% CI 0.68–1.98). However, ketamine–propofol was effective in reducing cardiovascular adverse events compared to ketamine (RR 0.11, 95% CI 0.04–0.31). Ketamine–propofol was also effective in reducing psychomimetic adverse events compared to ketamine (RR 0.39, 95% CI 0.16–0.93). In regard to nausea and vomiting, ketamine–propofol was significantly effective (RR 0.43, 95% CI 0.25–0.74). In addition, we could not demonstrate differences in efficacious sedation between ketamine–propofol and ketamine. Although our study was not able to demonstrate differences in efficacious sedation between ketamine–propofol and ketamine, we confirmed that ketamine–propofol sedation had a lower frequency of adverse events compared to ketamine sedation in children.