Eleven studies (n=957) were included in the review, ten (n=897) of which were randomised controlled trials (RCTs).
Seven of the RCTs were double-blind; the remaining three were not blinded.
Children (five studies, of which four were RCTs, n=329).
Hypotension appeared less pronounced in children receiving ketamine-propofol than comparators, but the number of cases requiring medical intervention was not reported. Few cases of ketamine-specific adverse effects were reported, although the authors acknowledged that adverse effects were not consistently reported in all of the included studies. Recovery time following the procedure was not statistically significantly different between the groups in two studies. In three studies children in the ketamine-propofol group were statistically significantly less likely to need additional sedation.
Adults (six RCTs, n=628).
One RCT found no difference between groups in the need for medical intervention for haemodynamic or respiratory compromise, and another favoured the ketamine-propofol group for this outcome. One RCT reported a higher incidence of post-operative nausea and emergent reaction in patients receiving the highest doses of ketamine (36% and 16%, respectively) than in patients receiving propofol alone (4% and 0%), with a longer time to discharge in the ketamine groups. In two RCTs, satisfaction scores were lower in the ketamine-propofol group than in the comparator groups. Discharge time was significantly shorter in the ketamine-propofol group in one RCT, significantly longer in two RCTs and not significantly different in another two RCTs. Fewer patients in the ketamine-propofol groups than in the comparator groups required additional sedation, but total cumulative doses were rarely reported.