Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Clin Cases. Mar 16, 2026; 14(8): 118582
Published online Mar 16, 2026. doi: 10.12998/wjcc.v14.i8.118582
Published online Mar 16, 2026. doi: 10.12998/wjcc.v14.i8.118582
Combination of N-methyl-D-aspartate receptor antagonists and propofol for procedural sedation
Muhammad Shaheer Bin Faheem, Department of Medicine and Surgery, Karachi Institute of Medical Sciences, Karachi 75080, Sindh, Pakistan
Syed Tawassul Hassan, Department of Internal Medicine, Karachi Medical and Dental College, KMDC, Karachi, 74700, Sindh, Pakistan
Faheem Feroze, Department of Anesthesiology, Combined Military Hospital Rawalpindi, Rawalpindi 46000, Punjab, Pakistan
Ayesha Khan, Department of Medicine, Allama Iqbal Medical College, Lahore 54000, Punjab, Pakistan
Syeda Umbreen Munir, Department of Internal Medicine, Hamdard University, Karachi 74600, Sindh, Pakistan
Ali Khaliq, Roni Mendonca, Department of Anesthesiology, New York City Health and Hospitals, Metropolitan, NY 10029, United States
Syeda Takreem Fatima, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan
Salim Surani, Department of Medicine, University of Houston, TX 77004, United States
Salim Surani, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Faheem MSB, Munir SU, Khan, A, Fatima ST, and Hassan ST contributed to the conceptualization and writing, review, and editing of the original draft; Faheem MSB and Surani S helped supervise the project; Faheem MSB, Feroze F, and Fatima ST contributed to data curation; Faheem MSB, Feroze F, and Khan A contributed to visualization; Faheem MSB and Khan A contributed to the formal analyses; Faheem MSB and Feroze F contributed to the validation; Faheem MSB, Hassan ST, and Mendonca R contributed to the project administration; Hassan ST and Munir SU contributed to the investigation; Feroze F and Khan A contributed to developing the software; Munir SU, Mendonca R, and Surani S were responsible for the resources.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Salim Surani, MD, FACP, FCCP, Professor, Department of Medicine, University of Houston, 4302 University Drive, TX 77004, United States.
Received: January 6, 2026
Revised: January 21, 2026
Accepted: February 4, 2026
Published online: March 16, 2026
Processing time: 69 Days and 18.6 Hours
Revised: January 21, 2026
Accepted: February 4, 2026
Published online: March 16, 2026
Processing time: 69 Days and 18.6 Hours
Core Tip
Core Tip: This meta-analysis of 19 randomized controlled trials evaluates the safety and efficacy of combining N-methyl-D-aspartate receptor antagonists, specifically ketamine and esketamine, with propofol for procedural sedation. Our pooled analysis demonstrates that this combination significantly reduces the risk of hypotension and the need for respiratory interventions compared to propofol monotherapy. However, clinicians must remain vigilant regarding the increased risk of transient hallucinations. These findings support the use of Ketofol and esketamine-propofol as valuable, hemodynamically stable alternatives for sedation in diverse clinical settings.