Evidence map›Paper›PMID 41826847›Full record

SynthesisBMC anesthesiology2026

Comparative safety of esketamine in procedural sedation and analgesia: a systematic review and network meta-analysis.

Baraah Abu Alsel, Abdulrahman Omar A Alali, Aryam Shannan K Alanazi, Safya E Esmaeel, Eslam Kamal Fahmy, Mohammed M Ismail, Manal S Fawzy, Yehia Nabil

Abstract readNetwork Meta-AnalysisSystematic ReviewComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Baraah Abu AlselMedical Sciences & Preparatory Year Department, North Private College of Nursing, Arar, Saudi Arabia.ORCID http://orcid.org/0000-0003-3811-0822
Abdulrahman Omar A AlaliFaculty of Medicine, Northern Border University, Arar, 91431, Saudi Arabia.ORCID http://orcid.org/0009-0004-5118-9146
Aryam Shannan K AlanaziFaculty of Medicine, Northern Border University, Arar, 91431, Saudi Arabia.ORCID http://orcid.org/0009-0004-6942-0246
Safya E EsmaeelDepartment of Physiology, College of Medicine, Northern Border University, Arar, 91431, Saudi Arabia.ORCID http://orcid.org/0000-0002-9313-2656
Eslam Kamal FahmyDepartment of Physiology, College of Medicine, Northern Border University, Arar, 91431, Saudi Arabia.ORCID http://orcid.org/0000-0002-1994-2570
Mohammed M IsmailDepartment of Anatomy, Faculty of Medicine, Northern Border University, Arar, 91431, Saudi Arabia.
Manal S FawzyCenter for Health Research, Northern Border University, Arar, 73213, Saudi Arabia.ORCID http://orcid.org/0000-0003-1252-8403
Yehia NabilFaculty of Medicine, Zagazig University, Zagazig, Egypt. ynabil577@gmail.com.ORCID http://orcid.org/0000-0002-1349-2978

Funding

Deanship of Scientific Research at Northern Border University, Arar, Saudi Arabia NBU-FFR-2026-3172-6
6 · The paper itself

Abstract

purposeThe safety of esketamine relative to other sedatives in procedural sedation remains incompletely elucidated. This systematic review and network meta-analysis evaluated the comparative safety of esketamine against commonly used sedative and analgesic agents across a range of respiratory, hemodynamic, and recovery outcomes.

methodsA systematic search of PubMed/MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science was conducted from 2000 to 2025 for randomized controlled trials (RCTs) comparing esketamine with other sedatives or placebo in patients undergoing procedural sedation. Primary outcomes included respiratory events (hypoxia) and hemodynamic stability (hypotension, bradycardia, vasoactive drug use). Secondary outcomes included recovery parameters (PACU discharge time) and drug consumption. A frequentist network meta-analysis was performed, and treatments were ranked using Surface Under the Cumulative Ranking Curve (SUCRA) values.

resultsThirty-nine RCTs involving 5,885 participants were included. Esketamine demonstrated a significantly lower risk of hypoxia compared to propofol (RR 6.11, 95% CI 1.91–19.57), sufentanil (RR 2.72, 95% CI 1.48–4.98), and fentanyl (RR 2.26, 95% CI 1.34–3.82). In terms of hemodynamic safety, esketamine was superior to propofol (RR 5.24, 95% CI 2.48–11.09), sufentanil (RR 3.05, 95% CI 1.84–5.06), and fentanyl (RR 2.18, 95% CI 1.54–3.08) in preventing hypotension. Propofol was also associated with the highest risk of requiring vasoactive drugs (RR 7.17 versus esketamine). Regarding recovery, opioid-free anesthesia (OFA) significantly reduced PACU discharge time compared to esketamine (MD -4.96 min), whereas propofol and remifentanil prolonged it.

conclusionEsketamine exhibits a favorable safety profile in procedural sedation, characterized by superior hemodynamic stability and a reduced risk of respiratory depression compared to conventional opioids and propofol. These findings support its utility as a valuable component in balanced sedation and opioid-sparing protocols, particularly for patients at risk of hemodynamic instability.

Indexed as

AnalgesiaAnalgesicsHypnotics and SedativesKetamineProcedural SedationHumansRandomized Controlled Trials as TopicAnalgesicsEsketamineHypnotics and SedativesKetamineEsketamineHypotensionNetwork meta-analysisProcedural sedationRespiratory depressionSafety

Identifiers

PMID41826847
PMCPMC13063517

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.