Efficacy and Safety of the Ketamine-Dexmedetomidine Combination in Adult Sedation and Anesthesia: A Systematic Review and Single-Arm Meta-Analysis of Randomized Controlled Trials.

Abstract

<h4>Background/objectives</h4>Ketodex (KD) combines ketamine's NMDA antagonism and sympathomimetic effects with dexmedetomidine's selective α₂-agonism, offering synergistic sedation, analgesia, and hemodynamic stability while limiting drug-specific drawbacks. This study aimed to describe the efficacy and safety profile of KD for adult sedation and anesthesia through a single-arm meta-analysis approach.<h4>Methods</h4>PubMed, Cochrane Library, ScienceDirect, and Web of Science were searched for randomized controlled trials (RCTs) of KD in adults. Eligible studies reported safety or efficacy outcomes. Only the KD treatment arms were quantitatively pooled. Data on analgesia, recovery, satisfaction, and adverse events were pooled with random-effects models; heterogeneity was assessed by I².<h4>Results</h4>Twenty RCTs (874 participants) were included. Analgesia was consistent (mean visual analog score ≤2 for two to 12 hours). Recovery was rapid (mean 15 minutes) with a 40-minute post-anesthesia stay. Patient satisfaction reached 71-88%; physician satisfaction was 41% excellent and 54% adequate. Hemodynamics remained stable (mean arterial pressure 86.7 mmHg; heart rate 80 bpm; SpO₂ 98%). Adverse events varied: bradycardia occurred in 9% (95% CI 4-20%) but rose to 38% in breast cancer surgery. Hypotension affected 10% (95% CI 6-16%). Oxygen desaturation was usually 5-12% but reached 55% during painful emergency procedures (I² 61%). Post-operative nausea/vomiting affected 17% overall, exceeding 40% in abdominal or obstetric surgery. Neuropsychiatric effects hallucinations (7%), agitation (6%), nightmares (5%), and involuntary movements (15%) were more frequent in urgent cases.<h4>Conclusions</h4>In this single-arm synthesis, KD provides effective sedation and analgesia with stable vital signs and high satisfaction. Nonetheless, bradycardia, desaturation, and nausea remain clinically relevant and procedure-dependent, requiring careful patient selection and vigilant monitoring.