Ali Ümit EŞBAH, Serkan TORUN
Düzce Tıp Fakültesi Dergisi - 2026;28(2):200-206
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 (SpO?) <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 SpO? 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.
