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World Journal of Clinical Cases
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis
Copyright: ©Author(s) 2026.
World J Clin Cases. Mar 16, 2026; 14(8): 118582
Published online Mar 16, 2026. doi: 10.12998/wjcc.v14.i8.118582
Table 1 Summary of baseline characteristics of the included studies, mean ± SD
Ref.Study designSample size (n)
Age in years
Dose (mg/kg)
Number of males, n (%)
SBP, mmHg
DBP, mmHg
Oxygen saturation (%)
Heart rate, bpm
MAP, mmHg
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Ferguson et al[17], 2016RCT29228146 ± 23.8450 ± 25.31 mg/kg propofol1:1 ketofol = 0.25 mg/kg propofol and 0.25 mg/kg ketamine145 ± 49138 ± 49NRNRNRNRNRNRNRNRNRNR
Miner et al[22], 2014RCT901:1 ketofol = 85; 4:1 ketofol = 9640 ± 17.051:1 = 39 (17.8); 4:1 = 36 (16)1 mg/kg propofol1:1 ketofol = propofol - 0.5 mg/kg, ketamine - 0.5 mg/kg, 4:1 ketofol = propofol - 0.8 mg/kg, ketamine - 0.2 mg/kg47 ± 521:1= 45 ± 53; 4:1= 51 ± 53127 ± 51.151:1 = 127 ± 17.79; 4:1 = 129 ± 14.83NRNR1001:1 = 100; 4:1 = 100NRNRNRNR
Ulutas et al[32], 2023RCT343053.65 ± 14.5746.27 ± 18.721 mg/kg propofol1:1 ketofol = 0.5 mg/kg ketamine + 0.5 mg/kg propofol25 ± 73.518 ± 60NRNRNRNRNRNRNRNRNRNR
Soliman et al[25], 2017RCT303014.48 ± 1.2614.09 ± 1.32A bolus dose of propofol (1-2 mg/kg) and then a continuous infusion of 50-100 μg/kg/minute1:1 ketofol = 1 mg/kg as a bolus dose and continued an infusion of 25-50 μg/kg/minute16 ± 53.5313 ± 43.33NRNRNRNRNRNR79.9 ± 7.579.0 ± 6.985.3 ± 6.985.1 ± 6.6
Kumar et al[26], 2020RCTNRNRNRNR1.5-2.5 mg/kg propofolIV ketamine 1 mg/kg followed by propofol 1-2 mg/kgNRNRNRNRNRNRNRNR84.7 ± 11.981.1 ± 9.795.6 ± 11.894.6 ± 9.1
Andolfatto et al[18], 2012RCT14214254 ± 24.4748 ± 30.390.75 mg/kg of propofol1:1 ketofol = 0.188 mg/ kg each of ketamine and propofol69 ± 4971 ± 50NRNRNRNRNRNRNRNRNRNR
Tandon et al[24], 2014RCT13513547 ± 1349 ± 12PropofolKetamine and propofol104 ± 77.03100 ± 74.04NRNRNRNRNRNRNRNRNRNR
Khalil et al[35], 2021RCT535326.49 ± 3.0627.68 ± 3.67Propofol (2 mg/kg)Propofol (1 mg/kg) plus ketamine (0.5 mg/kg)NRNRNRNRNRNRNRNRNRNRNRNR
Frey et al[23], 1999RCT3333NRNRPropofol3.3:1 ketofolNRNRNRNRNRNRNRNRNRNRNRNR
Cui et al[27], 2023RCT676865.6 ± 10.262.9 ± 9.6PropofolEsketamine and propofol42 ± 62.734 ± 50NRNRNRNRNRNRNRNRNRNR
Liu et al[28], 2025RCT12612665 ± 10.3864.5 ± 11.121 mg/kg propofol1 mg/kg propofol and 0.2 mg/kg esketamine61 ± 48.469 ± 54.8NRNRNRNRNRNRNRNRNRNR
Zheng et al[29], 2023RCT525241.1 ± 7.942.2 ± 9.32 mg/kg propofol2 mg/kg propofol and 0.25 mg/kg esketamine34 ± 65.3832 ± 61.53NRNRNRNRNRNRNRNRNRNR
Fu et al[19], 2024RCT2525 for all ratios of esketofol54.4 ± 2.75:1 esketofol = 49.88 ± 2.6; 3.3:1 esketofol = 48.9 ± 2.4; esketofol = 1.5:1 = 48.5 ± 3.02 mg/kg propofol5:1 = propofol 1 mg/kg with esketamine; 0.2 mg/kg; 3.3:1 = propofol 1 mg/kg with esketamine 3 mg/kg; 1.5:1 = propofol 1 mg/kg with esketamine 0.4 mg/kg10 ± 405:1 = 11 ± 27.5; 3.3:1 = 12 ± 48; 1.5:1 = 16 ± 64129.12 ± 21.585:1 = 127.04 ± 23.43; 3.3:1 = 126.0 ± 19.36; 1.5:1 = 120.84 ± 20.11 78.52 ± 16.355:1 = 78.76 ± 13.58; 3.3:1 = 78.12 ± 13.41; 1.5:1 = 75.56 ± 17.6499.76 ± 0.525:1 = 99.56 ± 1.04; 3.3:1 = 99.44 ± 1.08; 1.5:1 = 99.56 ± 1.50NRNR95.00 ± 17.065:1 = 92.16 ± 14.14; 3.3:1 = 92.96 ± 14.12; 1.5:1 = 89.12 ± 17.28
Beyoğlu et al[33], 2020RCT41343.23 ± 1.623.33 ± 1.771 mg/kg propofolKetofol19 ± 46.3421 ± 61.76NRNRNRNRNRNRNRNRNRNR
Frizelle et al[21], 1997RCT202059 ± 1355 ± 17Bolus of 0.5 mg/kg propofol, followed by continuous infusion of 1.5 mg/kg/hourInitial bolus of 0.4 mg/kg propofol and 0.1 mg/kg ketamine followed by continuous infusion of 1.2 mg/kg/hour propofol and 0.3 mg/kg/hour ketamine16 ± 8016 ± 80NRNRNRNRNRNRNRNRNRNR
Bhardwaj et al[30], 2024RCT292924 ± 13.3430 ± 22.24Propofol 0.5 mg/kg bolus1 mg/kg of ketamine and 0.5 mg/kg propofol19 ± 65.5117 ± 58.6NRNRNRNRNRNRNRNRNRNR
Schmitz et al[31], 2018RCT1671693.67 ± 3.263.91 ± 3.111 mg/kg propofolPropofol 0.5 mg/kg and ketamine 1 mg/kg89 ± 53.386 ± 52.4NRNRNRNR98 ± 0.7498 ± 1.48NRNRNRNR
Chiaretti et al[20], 2011RCT62597.3 ± 5.26.9 ± 5.42 mg/kg propofol2 mg/kg propofol and 0.5 mg/kg ketamine32 ± 5127 ± 44NRNRNRNRNRNRNRNRNRNR
Xu et al[43], 2024RCT42424.1 ± 1.44.2 ± 1.110 mg/mL propofol10:1 esketofol (propofol and esketamine)17 ± 40.4711 ± 26.19108 ± 13105 ± 11NRNRNRNR105 ± 16102 ± 1666 ± 1263 ± 12
bpm: Beats per minute; DBP: Diastolic blood pressure; MAP: Mean arterial pressure; NR: Not reported; RCT: Randomized controlled trial; SBP: Systolic blood pressure; SD: Standard deviation.
Full Size Table
Table 2 Summary of outcomes reported by each study, mean ± SD, n (%)
Ref.
Desaturation
Apnea
Occurrence of any respiratory intervention
Hypotension
Patient satisfaction with sedation
Recovery time (minutes)
Vomiting
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Ferguson et al[17], 201623 ± 817 ± 616 ± 511 ± 447 ± 1638 ± 1424 ± 83 ± 110 ± 010 ± 0NRNR8 ± 312 ± 4
Miner et al[22], 2014NRNR14 ± 161:1 = 10 ± 12; 4:1 = 15 ± 1641 ± 451:1 = 33 ± 39; 4:1 = 48 ± 50NRNR70 ± 781:1 = 61 ± 72, 4:1 = 78 ± 816 ± 4.451:1 = 10 ± 8.89; 4:1 = 8 ± 8.15NRNR
Ulutas et al[32], 2023NRNRNRNRNRNRNRNRNRNRNRNRNRNR
Soliman et al[25], 2017NRNRNRNRNRNR3 ± 102 ± 6.6NRNR26.3 ± 4.121.4 ± 3.7NRNR
Kumar et al[26], 2020NRNRNRNRNRNR18 ± 603 ± 10NRNRNRNRNRNR
Andolfatto et al[18], 201236 ± 2538 ± 2713 ± 915 ± 11NRNR1 ± 0.70NRNR6 ± 4.458 ± 2.22NRNR
Tandon et al[24], 2014NRNRNRNR19 ± 14.64 ± 316 ± 126 ± 4NRNR5 ± 2.224 ± 12.22NRNR
Khalil et al[35], 2021NRNRNRNRNRNRNRNRNRNRNRNRNRNR
Frey et al[23], 1999NRNRNRNR18 ± 54.59 ± 27NRNRNRNRNRNRNRNR
Cui et al[27], 2023NRNRNRNRNRNR14 ± 20.911 ± 16.210106 ± 1.486 ± 0.74NRNR
Liu et al[28], 2025NRNRNRNRNRNR46 ± 36.518 ± 14.3NRNRNRNRNRNR
Zheng et al[29], 2023NRNRNRNRNRNR12 ± 23.14 ± 7.7NRNRNRNR00
Fu et al[19], 20241 ± 4.0For all mixtures of esketofol = 0NRNRNRNR15 ± 60.0Propofol + esketamine 0.2 = 4 ± 16.0; propofol + esketamine 0.3 = 4 ± 16.0; popofol + esketamine 0.4 = 3 ± 12.05.0For all mixtures of esketofol = 5.0NRNRNRNR
Beyoğlu et al[33], 2020NRNRNRNRNRNRNRNRNRNR26.9 ± 6.1927.1 ± 5.41NRNR
Frizelle et al[21], 1997NRNR01NRNR4 ± 204 ± 20NRNRNRNRNRNR
Bhardwaj et al[30], 2024NRNRNRNRNRNRNR
NR
NRNR26.9 ± 6.1927.1 ± 5.41NRNR
Schmitz et al[31], 2018NRNRNRNRNRNRNRNRNRNR54 ± 29.6538 ± 31.874 ± 2.53 ± 1.9
Chiaretti et al[20], 2011 3/62 ± 4.81/59 ± 1.7NRNRNRNRNRNRNRNR20 ± 28 ± 2NRNR
Xu et al[43], 2024NRNRNRNRNRNRNRNRNRNRNRNRNRNR
NR: Not reported.
Full Size Table
Table 3 Summary of outcomes reported by each study, mean ± SD, n (%)
Ref.
SBP (mmHg)
DBP (mmHg)
MAP at different time points, T1, T2, and T3, (mmHg)
Heart rate at time points H1, H2, H3 (beats/minutes)
Airway events
Hallucinations
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Control
Intervention
Ferguson et al[17], 2016NRNRNRNRNRNRNRNR34 ± 1227 ± 946 ± 15100 ± 35
Miner et al[22], 2014NRNRNRNRNRNRNRNR19 ± 211:1 = 10 ± 12; 4:1 = 25 ± 26NRNR
Ulutas et al[32], 2023t1 = 140.23 ± 2.75, t2 = 143.61 ± 26.40, t3 = 143.79 ± 27.65t1 = 131.06 ± 1.71; t2 = 157.53 ± 2.83 t3 = 156.46 ± 24.37t1 = 83.64 ± 10.86 t2 = 89.47 ± 16.69 t3 = 86.70 ± 16.71t1 = 72.36 ± 9.07; t2 = 92.50 ± 17.67; t3 = 83.96 ± 12.69t1 = 102.51 ± 13.24; t2 = 107.52 ± 16.88; t3 = 105.74 ± 18.07t1 = 91.93 ± 9.52; t2 = 114.18 ± 18.32; t3 = 108.13 ± 14.79h1 = 94.85 ± 15.45; h2 = 97.35 ± 19.66; h3 = 94.91 ± 17.36h1 = 92.53 ± 16.53; h2 = 102.87 ± 19.51; h3 = 105.47 ± 16.60NRNRNRNR
Soliman et al[25], 2017NRNRNRNR85.3 ± 6.985.1 ± 6.6No different time points. 79.9 ± 7.579.0 ± 6.9NRNRNRNR
Kumar et al[26], 2020NRNRNRNRImmediate postinduction = 83.6 ± 11.7, 3 minutes = 70.1 ± 6.8, 1 minute postintubation = 101.4 ± 13.1, 3 minutes = 90.4 ± 14.2, 5 minutes = 85.3 ± 14.7, 10 minutes = 83.5 ± 14.5Immediate postinduction = 90.4 ± 8.8, 3 minutes = 85.2 ± 8.0, 1 minute postintubation = 92.7 ± 7.7, 3 minutes = 89.2 ± 6.5, 5 minutes = 89.2 ± 6.2, 10 minutes = 88.1 ± 6.0Immediate postinduction = 79.2 ± 8.6, 3 minutes = 65.7 ± 5.4, 1 minute postintubation = 103.5 ± 12.4, 3 minutes = 94.1 ± 8.9, 5 minutes = 86.9 ± 9.4, 10 minutes = 81.3 ± 9.9Immediate postinduction = 82.2 ± 11.3, 3 minutes = 80.8 ± 12.4, 1 minute postintubation = 84.8 ± 9.5, 3 minutes = 88.0 ± 15.8, 5 minutes = 84.6 ± 15.4, 10 minutes = 82.2 ± 15.0NRNRNRNR
Andolfatto et al[18], 2012NRNRNRNRNRNRNRNR14 ± 105 ± 4NRNR
Tandon et al[24], 2014NRNRNRNRNRNRNRNRNRNRNRNR
Khalil et al[35], 2021NRNRNRNRT1 = 115, T2 = 110, T3 = 105, T4 = 100, T5 = 95, T6 = 90T1 = 110; T2 = 105; T3 = 100; T4 = 95; T5 = 90; T6 = 85T1 = 105; T2 = 100; T3 = 95; T4 = 90; T5 = 85; T6 = 80T1 = 85; T2 = 90; T3 = 85; T4 = 80; T5 = 75; T6 = 70NRNRNRNR
Frey et al[23], 1999NRNRNRNRNRNRNRNRNRNRNRNR
Cui et al[27], 2023NRNRNRNRt1 = 100; t2 = 100; t3 = 85; t4 = 83; t5 = 80; t6 = 83; t7 = 84; t8 = 83t1 = 100; t2 = 99; t3 = 89; t4 = 85; t5 = 84; t6 = 86; t7 = 89; t8 = 89NRNRNRNR01 ± 1.5
Liu et al[28], 2025NRNRNRNRNRNRNRNRNRNR2 ± 1.63 ± 2.4
Zheng et al[29], 2023t1 = 124; t2 = 110; t3 = 103; t4 = 140; t5 = 120t1 = 123; t2 = 120; t3 = 120; t4 = 124; t5 = 125t1 = 71; t2 = 65; t3 = 60; t4 = 76; t5 = 69t1 = 70; t2 = 69; t3 = 68; t4 = 70; t5 = 69NRNRt1 = 75; t2 = 70; t3 = 68; t4 = 83; t5 = 75t1 = 75; t2 = 74; t3 = 73; t4 = 77; t5 = 75NRNRNRNR
Fu et al[19], 2024NRNRNRNRNRNRNRNRNRNRNRNR
Beyoğlu et al[33], 202084.5 ± 9.985.2 ± 14.448.8 ± 9.152.1 ± 6.9NRNRNRNRNRNRNRNR
Frizelle et al[21], 1997NRNRNRNRNRNRNRNRNRNRNRNR
Bhardwaj et al[30], 2024NRNRNRNRNRNRNRNRNRNRNRNR
Schmitz et al[31], 2018NRNRNRNRNRNRNRNRNRNRNRNR
Chiaretti et al[20], 2011 NRNRNRNRNRNRNRNRNRNRNRNR
Xu et al[43], 20240 minute = 109; 5 minutes = 99; 10 minutes = 100; 15 minutes = 102; 20 minutes = 101; 25 minutes = 104; 30 minutes = 107; 35 minutes = 104; 40 minutes = 102; 45 minutes = 98; 50 minutes = 97; 55 minutes = 97; 60 minutes = 970 minute = 42;
5 minutes = 42; 10 minutes = 42; 15 minutes = 42; 20 minutes = 40; 25 minutes = 40; 30 minutes = 33; 35 minutes = 25; 40 minutes = 19; 45 minutes = 15; 50 minutes = 12; 55 minutes = 11; 60 minutes = 11		0 minute = 66;
5 minutes = 55; 10 minutes = 58; 15 minutes= 62; 20 minutes = 63;
25 minutes = 64; 30 minutes = 62; 35 minutes = 62; 40 minutes = 60; 45 minutes = 58; 50 minutes = 55; 55 minutes = 52; 60 minutes = 43		0 minute = 64;
5 minutes = 56; 10 minutes = 67; 15 minutes = 54; 20 minutes = 66; 25 minutes = 51; 30 minutes = 61; 35 minutes = 61; 40 minutes = 59; 45 minutes = 54; 50 minutes = 50; 55 minutes = 51; 60 minutes = 50		NRNRNRNRNRNRNRNR
DBP: Diastolic blood pressure; MAP: Mean arterial pressure; NR: Not reported; SBP: Systolic blood pressure.
Full Size Table
Table 4 Summary of meta-regression findings for hypotension outcome, showing direction and approximate trend of associations between covariates (propofol dosage, mean age, and ketamine dosage) and log risk ratio
Covariate (moderator)
Direction of association
Approximate trend
Propofol dosage difference (msg)Positive Each 50 mg increase in propofol appeared to increase LogRR by approximately 0.05-0.10
Mean age (years)Slighty negative Each approximately 10 years increase in mean age appeared to decrease LogRR by approximately 0.01 (very weak)
Ketamine dosage difference Negative Each 50 mg increase in ketamine appeared to decrease LogRR by approximately 0.05-0.08
LogRR: Log risk ratio.
Full Size Table
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