Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Medical science monitor : international medical journal of experimental and clinical research
Capnography With Integrated Pulmonary Index for Preventing Hypoxemia During Pediatric Urologic Surgery Under Sedation: A Randomized Controlled Trial
BACKGROUND Procedural sedation and analgesia (PSA) can relieve pain and anxiety during invasive procedures. Carbon dioxide (CO₂) monitoring or integrated pulmonary index (IPI) can reduce respiratory depression in adults with PSA, but the effect of the combination of these 2 methods on intraoperative hypoxemia in pediatric urologic surgery is unclear. This study was conducted to determine whether capnography combined with IPI could lessen intraoperative hypoxemia during pediatric urinary procedures with PSA. MATERIAL AND METHODS We conducted a randomized controlled trial (ChiCTR 2300073943). Children referred for urinary procedures with PSA were randomly assigned to either a control group with standard monitoring or an intervention group with standard monitoring combined with capnography and IPI monitoring. The primary outcome was intraoperative hypoxemia. Secondary outcomes were severe intraoperative hypoxemia, airway management, and perioperative complications. RESULTS A total of 133 patients completed the analysis (67 in the intervention group and 66 in the control group). Compared with the control group, the incidence of intraoperative oxygen saturation decline was significantly lower in the intervention group (34.33% vs 56.06%, odds ratio=0.410, 95% confidence interval: 0.203-0.825, P=0.012). Simultaneously, the incidence of severe oxygen desaturation (SpO₂ <90%) was also significantly reduced in the intervention group (19.40% vs 36.40%, odds ratio=0.421, 95% confidence interval: 0.192-0.925, P=0.034). Regarding airway management interventions, the intervention group exhibited a higher frequency of jaw thrust maneuvers (1.84±1.31 vs 1.17±1.12 times, P=0.004) and a significantly reduced need for invasive positive-pressure ventilation (1.64±1.31 vs 2.39±1.48, P=0.002). No differences in other airway management techniques or perioperative complications were observed between the 2 groups. CONCLUSIONS The addition of capnography and IPI monitoring to standard monitoring reduces the risk of intraoperative hypoxemia in pediatric urologic surgery and reduces the need for aggressive ventilation through early intervention.
12 May 2026
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Efficacy and Safety of Ketamine or Esketamine versus Fentanyl-Class Opioids as Adjuncts to Propofol for Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis
OBJECTIVE: Propofol is widely used for gastrointestinal (GI) endoscopies but may cause respiratory depression and hemodynamic compromise when used alone. Adjuncts such as ketamine or esketamine and fentanyl-class opioids (fentanyl, alfentanil, and sufentanil) are used to optimize sedation, yet their comparative efficacy and safety remain uncertain. This meta-analysis evaluated ketamine or esketamine plus propofol (KP regimens) versus fentanyl/alfentanil/sufentanil plus propofol (FP regimens). METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Scopus, Cochrane Library, and Google Scholar from inception to February 2025 for randomized controlled trials (RCTs). Eligible studies included patients undergoing GI endoscopy (Population), receiving ketamine or esketamine with propofol (Intervention), compared with fentanyl-class opioids with propofol (Comparison), and reporting outcomes including propofol dose, comfort, adverse events, recovery time, or procedure time (Outcomes). Risk of bias was assessed with the Cochrane tool. Heterogeneity was evaluated using Cochran's Q test and the I2 statistic, and clinical heterogeneity was considered based on study design and population differences. Sensitivity analyses were conducted to test robustness of findings. RESULTS: Fifteen RCTs (1492 participants) were included. KP regimens significantly reduced total propofol use compared with FP (mean difference [MD] -0.42; 95% confidence interval [CI] -0.66 to -0.19; P = .0005), with greater benefit observed for esketamine (p for subgroup = 0.001). No significant differences were found in sedation (MD 0.01; 95% CI -0.40 to 0.43; P = .95) or pain scores (MD 0.24; 95% CI -0.18 to 0.65; P = .26). Safety outcomes were comparable across groups, with no significant differences in desaturation, nausea/vomiting, bradycardia, or tachycardia, except for hypotension, which was lower with KP (risk ratio [RR] 0.56; 95% CI 0.39 to 0.82; P = .003). Recovery and procedure times were similar between groups. CONCLUSIONS: Both KP and FP regimens are effective and safe for GI endoscopy. KP regimens reduce total propofol requirements and significantly lower the risk of hypotension, while showing comparable sedation quality, analgesia, and recovery profiles to FP. These findings suggest KP may offer safety and dosing advantages, though larger standardized trials are needed to confirm its clinical superiority.
10 Apr 2026
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