A Prospective Case Series of Single‐syringe Ketamine–Propofol (Ketofol) for Emergency Department Procedural Sedation and Analgesia in Adults

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:237–245 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to evaluate the effectiveness, recovery time, and adverse event profile of intravenous (IV) mixed 1:1 ketamine–propofol (ketofol) for adult procedural sedation and analgesia (PSA) in the emergency department (ED). Methods: Prospective data were collected on all PSA events over a 4.5‐year period in a trauma‐receiving suburban teaching hospital. PSAs using a 1:1 single‐syringe mixture of 10 mg/mL ketamine and 10 mg/mL propofol in patients over 21 years of age were analyzed. Physiologic data, drug doses, adverse events, recovery time, patient satisfaction, and staff satisfaction were recorded. Results: Ketofol PSA was used in 728 patients for primarily orthopedic procedures. Median patient age was 53 years (range = 21 to 99 years, interquartile range [IQR] = 36–70 years). The median dose of ketamine and propofol was 0.7 mg/kg each (range = 0.2 to 2.7 mg/kg, IQR = 0.5–0.9 mg/kg), and median recovery time was 14 minutes (range = 3 to 50 minutes, IQR = 10–17 minutes). PSA was effective in 717 cases (98%). Bag–mask ventilation occurred in 15 patients (2.1%; 95% confidence interval [CI] = 1.0% to 3.1%). Recovery agitation occurred in 26 patients (3.6%; 95% CI = 2.2% to 4.9%), of whom 13 (1.8%; 95% CI = 0.8% to 2.7%) required treatment. One patient experienced vomiting and one patient was admitted to the hospital for monitoring of transient dysrhythmia and hypotension. No sequelae were identified. The median staff satisfaction scores were 10 (IQR = 9–10) on a scale of 1 to 10, and 97% of patients would have chosen the same method of PSA in the future. Conclusions: Ketofol is an effective PSA agent in adult ED patients. Recovery times are short and adverse events are few. Patients and ED staff were highly satisfied.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: A randomized prospective study

“…In previous studies, the use of a ketofol mixture in a single syringe was suggested as safe for use in an emergency unit and in orthopedic procedures for support of regional anesthesia (17)(18)(19). Willman et al (20) reported that the use of ketofol was safe for painful procedures in an emergency unit.…”

The Comparison of Propofol and Ketofol Side Effects During Sedation with Spinal Anesthesia

“…32,33 The estimated incidence of recovery agitation in adults receiving ketamine has been reported as between 10% and 20% 34 . Aldonfatto et al 28 have reported that the agitation Propofol has many advantages during sedation such as fast induction, fast recovery and easy regulation of sedation level 7,8 . Its anti-emetic property is an another advantage during sedation.…”

“…So a combination with a high ketamine ratio, for example 1:1, may be more beneficial in a short procedural sedation rather than long-term sedation infusions, especially in terms of adverse events. Aldonfatto et al 28 analysed 728 ketofol procedural sedations with a 1:1 ratio and found the combination effective enough in terms of analgesia, recovery times and satisfaction, with few adverse events. Akin et al 29 showed that low-dose ketamine in a cardiac catheterization procedure provided a reduced opioid requirement, with a better haemodynamic profile.…”

Changing Trends in Dental Procedural Sedation

“…A number of studies have demonstrated that the varying proportion of combination in ketofol (1:1 to 1:10 in mg) for sedation is safe and effective. The combination of the two agents appear to reduce side-effects of each medication used alone, and allows for a rapid recovery time [35,36,[39][40][41][42] . The optimal ratio of ketamine to propofol in ketofol has not been defined yet.…”

“…Incidences of delirium and other side-effects can be minimized by limiting the dose of ketamine or using it in conjunctions with other sedative hypnotic. Commonly used combination medications with ketamine are midazolam, propofol and dexmedetomidine [34][35][36][37] . Ketofol: Combination of ketamine and propofol is called ketofol, is a potentially alternative for procedural sedation, they are mostly combined together in same single syringe and are physically compatible for one hour at 23°C [38] .…”