Propofol–fentanyl versus propofol–ketamine for procedural sedation and analgesia in patients with trauma

Aminiahidashti, Hamed; Shafiee, Sajad; Hosseininejad, Seyed Mohammad; Firouzian, Abulfazl; Barzegarnejad, Ayyub; Kiasari, Alieh Zamani; Kerigh, Behzad Feizzadeh; Bozorgi, Farzad; Shafizad, Misagh; Geraeeli, Ahmad

doi:10.1016/j.ajem.2018.01.080

Cited by 13 publications

(32 citation statements)

References 17 publications

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“…In one of them, Aminiahidashti et al, reported that propofol/fentanyl resulted in deeper sedation, better analgesic effects, and higher pain reduction compared to propofol/ketamine. Moreover, no considerable difference was observed between the two groups in terms of respiratory adverse events (19). In another study, Khajavi et al, compared the effect of a bolus IV injection of ketofol with that of fentanyl/propofol combination during the colonoscopy procedure and, in this study, similar to that of Aminiahidashti et al, the respiratory adverse events were not different between the pa-tients receiving propofol/fentanyl and those subjected to ketofol (56).…”

Section: Propofol/fentanyl Versus Ketofolsupporting

confidence: 63%

“…Fentanyl is an ultrashort-acting sedative, which is used in combination with another agent for PSA. In this regard, a combination of fentanyl and propofol is used to prevent dyspareunia since propofol exerts no analgesic effect (19).…”

Section: Contextmentioning

confidence: 99%

“…In the present literature review, there were three studies comparing propofol/fentanyl with ketofol for PAS in patients referring to EDs (19,56,57). In one of them, Aminiahidashti et al, reported that propofol/fentanyl resulted in deeper sedation, better analgesic effects, and higher pain reduction compared to propofol/ketamine.…”

Section: Propofol/fentanyl Versus Ketofolmentioning

confidence: 99%

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Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

et al. 2020

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: The current systematic review aimed at investigating different medications commonly used for procedural sedation and analgesia (PSA) in emergency departments (EDs) for adults. The articles related to the subject of interest were searched in five electronic databases, including Google Scholar, PubMed, Medline, Web of Science, Scopus, and Embase, up to 2019. The blinded, randomized, controlled, clinical trials comparing common PSA medications, including midazolam, etomidate, propofol, fentanyl, ketamine, and ketofol, among the adults undergoing PSA in EDs were included in the study. The search process resulted in the inclusion of 35 papers in the study. The main information, including clinical features, sedation duration, recovery time, and incidence of adverse events, was extracted from the selected studies. Based on the reviewed studies, various combinations of medications are used for PSA depending on the hospital protocols and policies; however, there is still controversy over the best choice. As the results of the retrieved articles indicated, propofol is the most common medication used for PSA in EDs due to the shorter time of induction, rapid recovery of consciousness, and fewer side effects. Etomidate and ketamine were also identified as other common sedatives applied for PSA.

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Section: Propofol/fentanyl Versus Ketofolsupporting

confidence: 63%

Section: Contextmentioning

confidence: 99%

Section: Propofol/fentanyl Versus Ketofolmentioning

confidence: 99%

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Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

et al. 2020

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“…All studies described the comparison of low-dose ketamine versus fentanyl as the opioid of choice with propofol for procedural sedation in the ED [6,7,16,17]. All studies were published between 2008 and 2022.…”

Section: Study Characteristicsmentioning

confidence: 99%

Low-dose ketamine or opioids combined with propofol for procedural sedation in the emergency department: a systematic review

Vries¹,

Veeger

Roon

et al. 2023

European Journal of Emergency Medicine

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Procedural sedation is routinely performed for procedures in the emergency department (ED). Propofol is a commonly used sedative, frequently combined with an opioid or low-dose ketamine as an analgesic. However, there is still controversy on the optimal combination of agents in current guidelines. The objective of this systematic review is to identify and present studies comparing low-dose ketamine to opioids when combined with propofol for procedural sedation in the ED and to describe the dosing regimen, observed efficacy, and side effects. For this systematic review, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, EMBASE and PubMed databases were searched. Studies comparing propofol with opioids versus propofol with low-dose (es)ketamine in patients undergoing procedural sedation for procedures in the ED were included. Analyses were descriptive because of the high heterogeneity among included studies. The outcomes were dosing regimen, efficacy of analgesia, efficacy of sedation depth, efficacy of recovery and (adverse) events. We included four out of 2309 studies found in the literature search. Overall, the studies had a low risk of bias, but the Grading of Recommendations Assessment, Development, and Evaluation evidence profile was downgraded due to the imprecision and inconsistency of the studies. All studies compared low-dose ketamine with fentanyl. Dosing ranged from 0.3 to 1.0 mg/kg (ketamine), 1.0–1.5 μg/kg (fentanyl) and 0.4–1.0 mg/kg (propofol). The efficacy of analgesia was measured by two studies, one favoring the fentanyl group, and one favoring the ketamine group. The efficacy of sedation depth was measured by one study, with the fentanyl group having a deeper sedation score. Two studies showed shorter recovery time with low-dose ketamine. One study showed a higher incidence of cardio-respiratory clinical events and interventions in the fentanyl group. Two studies showed significant differences of overall sedation events in the fentanyl group. One study did not find any significant differences of the incidence of sedation events. This systematic review did not provide sufficient evidence that the combination of low-dose ketamine and propofol is associated with a shorter recovery time and fewer sedation events compared to the combination of opioids and propofol.

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“…Recent experiences show that do not raise intracranial pressure as was once assumed and does raise blood pressure improving cardiovascular stability, unlike most sedating drugs [6]. Also, a drug should be considered extremely helpful for acute invasive procedures that need to be performed under sedation [7,8], offering a great advantage of analgesia and respiratory stability at the same time. Ketamine is known an optimal drug in various emergency settings.…”

Section: Pharmacologic Propertiesmentioning

confidence: 99%

The Role of Ketamine in Trauma

Botea¹,

Bimbo-Szuhai²

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

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Early and effective pain control in trauma patients improves outcomes and limits disability, but analgesia is often missed in the unstable patient, or hemodynamically depressing medications are avoided for fear of losing stability. This chapter outlines the role of ketamine in managing traumatic emergencies in both out-of-hospital and hospital environment, and beyond. Low-dose ketamine also called a sub-dissociative dose is safe, efficient and effective analgesic that can be considered for trauma patients, pediatric or adults, as an alternative to opioids or in combination with opioids for on additive or synergistic effect, with minimal impact on hemodynamic stability. Ketamine at higher doses is also an excellent drug for induction of anesthesia in rapid sequence induction (RSI), post-intubation sedation maintenance or procedural sedation in the trauma patient. Also, can be used for acute agitation and excited delirium. In this chapter, we are describing this drug focusing on a deeper understanding of the safety and efficacy of this agent and, if supported, to encourage physicians to consider ketamine for pain control in trauma and beyond. Also, we are presenting the current literature surrounding ketamine’s evidences in the trauma condition to establish its utility and profile of safety for these patients.

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Propofol–fentanyl versus propofol–ketamine for procedural sedation and analgesia in patients with trauma

Cited by 13 publications

References 17 publications

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

Low-dose ketamine or opioids combined with propofol for procedural sedation in the emergency department: a systematic review

The Role of Ketamine in Trauma

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