Implementation of a protocol using ketamine-propofol (‘ketofol’) in a 1 to 4 ratio for procedural sedation in adults at a university hospital emergency department – report on safety and effectiveness

Walravens, Stig; Buylaert, Walter; Steen, Elke Van Den; Paepe, Peter De

doi:10.1080/17843286.2020.1741228

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…The three sedatives PK25, PK20, and P was selected by three experts' choice and used by them each. All sedation was undergone according to the sedative protocol with reference to the previously used drug combination [14][15][16]. Then, 1-2 mL of each sedative agents was additionally administered, and in some cases, 5-10 µg fentanyl was added if patient movements interfered with the procedure after the initial bolus administration.…”

Section: Anesthetic Methodsmentioning

confidence: 99%

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

Joo

Yu²,

Koh³

2022

Medicina

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Background and objectives: Procedural sedation for bone marrow examination (BME) and intrathecal chemotherapy (ITC) is necessary for pediatric patients with hematological malignancies. There has been no report on adverse events after discharge from the recovery room. This retrospective study evaluated the types and incidences of delayed adverse events among pediatric patients scheduled for BME or ITC under deep sedation in a single center for 3 years. Materials and Methods: The patients were divided into two groups: inpatients (group I) and outpatients (group O). All patients were managed during the procedures and the recovery period. In total, 10 adverse events were assessed; these occurred 2 h (T1, acute), 12 h (T2, early), and 24 h (T3, delayed) after the procedure. The duration of each adverse event was also recorded and was classified as 2 h (D1), 12 h (D2), or 24 h (D3). The data of 263 patients (147 inpatients and 116 outpatients) who met the inclusion criteria were analyzed. Results: The overall incidence of adverse events was statistically significant difference: 48.3% in group I and 33.6% in group O (p = 0.011). The rates of adverse events at T1 and T2 were significantly different between groups I and O (42.8% vs. 11.2% and 7.5% vs. 20.7%, respectively) (p < 0.001). The adverse events were mostly of D1 or D2 duration in both groups. Patients with a higher proportion of ketamine in a propofol–ketamine mixture had a significantly higher proportion of adverse events at T1 (34.6%), as compared with those with a mixture with a lower proportion of ketamine (21.1%) or propofol alone (17.9%) (p = 0.012). Conclusions: The most common adverse events were dizziness or headache; typically, they did not last longer than 12 h. The propofol-ketamine combination with a higher proportion of ketamine seems to produce more adverse events within 2 h after the procedure. Nevertheless, all sedative types appear safe to use without additional management.

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Section: Anesthetic Methodsmentioning

confidence: 99%

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

Joo

Yu²,

Koh³

2022

Medicina

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Modern Sedation and Analgesia Strategies in Neurocritical Care

Bauerschmidt

Al-Bermani

Ali

et al. 2023

Curr Neurol Neurosci Rep

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Procedural (Conscious) Sedation and Analgesia in Emergency Setting: How to Choose Agents?

Ayan,

Ozsoy,

Ozbay

et al. 2023

CPD

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Pain has long been defined as an unpleasant sensory and emotional experience originating from any region of the body in the presence or absence of tissue injury. Physicians involved in acute medicine commonly undertake a variety of invasive and painful procedures that prompt procedural sedation and analgesia (PSA), which is a condition sparing the protective airway reflexes while depressing the patient’s awareness of external stimuli. This state is achieved following obtaining the patient’s informed consent, necessary point-ofcare monitoring, and complete recording of the procedures. The most commonly employed combination for PSA mostly comprises short-acting benzodiazepine (midazolam) and a potent opioid, such as fentanyl. The biggest advantage of opioids is that despite all the powerful effects, upper airway reflexes are preserved and often do not require intervention. Choices of analgesic and sedative agents should be strictly individualized and determined for the specific condition. The objective of this review article was to underline the characteristics, effectiveness, adverse effects, and pitfalls of the relevant drugs employed in adults to facilitate PSA in emergency procedures.

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Implementation of a protocol using ketamine-propofol (‘ketofol’) in a 1 to 4 ratio for procedural sedation in adults at a university hospital emergency department – report on safety and effectiveness

Cited by 3 publications

References 24 publications

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

Delayed Adverse Events after Procedural Sedation in Pediatric Patients with Hematologic Malignancies

Modern Sedation and Analgesia Strategies in Neurocritical Care

Procedural (Conscious) Sedation and Analgesia in Emergency Setting: How to Choose Agents?

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