Ketofol vs Propofol Sedation in Advanced Endoscopic Procedures: Impact on Hypoxemia and Airway Intervention
Abstract
Aim: Advanced endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation, during which respiratory complications remain a major concern. This study aimed to compare the effects of propofol and a ketamine–propofol combination (ketofol) on hypoxemia and airway intervention.
Material and Methods: This retrospective, single-center observational study included 125 adult participants who underwent EUS or ERCP and received either propofol (n=63) or ketofol (n=62) sedation. The primary outcome was hypoxemia, defined as peripheral oxygen saturation (SpO₂) <90% sustained for at least 10 seconds, and the secondary outcome was the requirement for an airway intervention. Clinical, procedural, and sedation-related variables were analyzed.
Results: Hypoxemia occurred in 18 (28.6%) participants in the propofol group and 9 (14.5%) participants in the ketofol group (p=0.056). The lowest recorded SpO₂ was lower in the propofol group than in the ketofol group (91.2±4.8% vs 93.6±3.9%, p=0.003). Airway intervention was required in 14 (22.2%) and 6 (9.7%) participants, respectively (p=0.056). Ketofol sedation was independently associated with a lower risk of hypoxemia (adjusted odds ratio: 0.42, 95% confidence interval: 0.18-0.98, p=0.044). Older age, higher body mass index, American Society of Anesthesiologists physical status class III-IV, and longer procedure duration were independently associated with an increased risk of hypoxemia.
Conclusion: Ketofol sedation was independently associated with a lower risk of hypoxemia than propofol alone in patients undergoing advanced endoscopic procedures. These findings suggest that ketofol may offer a potential respiratory safety advantage, although prospective randomized studies are needed to confirm this association.
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Ethical Statement
References
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Details
Primary Language
English
Subjects
Gastroenterology and Hepatology
Journal Section
Research Article
Publication Date
August 21, 2026
Submission Date
April 29, 2026
Acceptance Date
August 6, 2026
Published in Issue
Year 2026 Volume: 28 Number: 2
