A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single‐syringe Ketamine–Propofol Combination (Ketofol)

Abstract

Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children.Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg ⁄ mL ketamine and 10 mg ⁄ mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded.Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg ⁄ kg each of ketamine and propofol (range = 0.2 to 3.0 mg ⁄ kg; IQR = 0.7 to 1.0 mg ⁄ kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale.Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied.

Sedation with the Combination of Ketamine and Propofol in a Pediatric ED: A Retrospective Case Series Analysis

“…The combination of ketamine and propofol has gained popularity in recent years because the drugs are thought to complement one another [2][3][4][5][6][7]. Theoretically, the antiemetic and anxiolytic properties of propofol can mitigate the vomiting and emergence reactions induced by ketamine, whereas the sympathomimetic effect of ketamine can mitigate the hypotension induced by propofol [3].…”

Ketamine‐Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

“…3 Furthermore, adding ketamine to propofol may reduce the potential for hemodynamic instability while providing deep sedation and analgesia to patients. 4,5 However, ketamine may precipitate nausea or vomiting, while propofol has intrinsic antiemetic properties. 6 Postprocedural agitation is a common side effect of using ketamine, while propofol is known to be an anxiolytic.…”

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

“…The goals of procedural sedation are to provide an adequate level of sedation while minimizing pain, stable cardiovascular and respiratory status. 8 Propofol used for the induction and maintenance of general anesthesia as a short-acting intravenous sedative agent. Ketamine is a phencyclidine anesthetic that produces intense analgesia.…”

“…Ketamine is a phencyclidine anesthetic that produces intense analgesia. 8 The combination of ketamine with propofol produces favorable adverse event and recovery time profiles. 9 This study was designed to evaluate the use of ketofol ketamine/ propofol mixtures in two different ratios (1:3 and 1:5) for sedation and analgesia for intrathecal injection of chemotherapy drugs in leukemic children.…”