Eficacia y seguridad de ketamina + dexmedetomidina versus propofol en la sedación para endoscopias digestivas altas: una revisión sistemática

Abstract

Introduction: Sedation for upper gastrointestinal endoscopy requires effective medications to ensure hemodynamic stability and patient comfort. Although propofol is frequently used, it can cause adverse effects. The combination of ketamine and dexmedetomidine (Ketodex) has emerged as an alternative with a better safety profile. Objective: To compare the efficacy and safety of Ketodex versus propofol in adult patients undergoing upper gastrointestinal endoscopy. Methodology: The review included studies published between 2019 and 2024, in English or Spanish, focused on patients over 18 years of age. Systematic reviews, meta-analyses, and case reports were excluded. The search was conducted between November 2024 and April 2025 in the following databases: PubMed, Scopus, Taylor & Francis, and Google Scholar. The risk of bias was assessed using the RoB 2 and JBI tools. Results: A total of 14 studies were analyzed, including clinical and observational trials, with a total sample size of more than 1,000 participants. Data were organized into comparative tables with clinical variables, outcomes, and adverse events. Ketodex demonstrated greater hemodynamic stability and faster recovery, whereas propofol was associated with higher rates of desaturation and hypotension. Discussion: The main limitations were methodological heterogeneity and the risk of bias in some studies. Despite these limitations, the results with Ketodex were clinically relevant. Conclusion: The combination of ketamine and dexmedetomidine represents an effective and safer alternative to propofol for sedation during upper gastrointestinal endoscopy.