Sedative and analgesic effects of propofol–ketamine versus propofol–fentanyl for emergency department procedures

Abstract

Background: To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short-acting intravenous sedative drugs in the field of emergency medicine. Objectives: This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures. Methods: This study was a randomized, double-blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl–propofol or ketamine–propofol. For data gathering, pre-procedure, and procedure, modified Aldrete’s scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t-test, chi-square test, and analysis of variance. Results: Among the participants in this study, shoulder procedure was performed more than other procedures (56.6%). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). “Hypotension and bradycardia” were observed with fentofol and “tachycardia” was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures. Conclusion: Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension.

Ketamine as the main analgesic agent during analgesia-based sedation for elective colonoscopy – A randomised, double-blind, control study

“…In a previous randomized, blinded study of adult patients undergoing sedation in emergency department, the median recovery time was 13 min for the ketamine group. [ 24 ] Which is in line with our results, where we recorded ARS 15 min after the procedure. Ratio of ketamine-propofol 1: 1 showed better results of post-operative analgesia compared to propofol, however, it resulted in a longer recovery time which can be explained by a shorter half-life of propofol.…”

Comparison of recovery time of ketamine versus nalbuphine used in combination with propofol in females undergoing in-vitro fertilization under intravenous sedation.

“…This difference in results could be due to different methodology. 15 Panjabi et al did not find significant difference in the recovery time when comparing nalbuphine and fentanyl for post-operative pain relief in patient undergoing short surgical procedures. (8.8 ± 1.0 minutes vs 7.8 ± 1.5 min).…”

“…7 Ketamine in combinations with propofol provide analgesic effect, shorter recovery time with decreased incidence of vomiting. 10,15 Various combinations with propofol have been studied earlier but none has been done to compare propofol-ketamine with propofol-nalbuphine. Thus, the objective of this study was to compare the mean recovery time after administration of propofol-ketamine versus propofol-nalbuphine combination in patients undergoing in-vitro fertilization procedures under intravenous sedation.…”

Large animal models for cardiac remuscularization studies: A methodological review

“…Ketofol has also been found to reduce adverse respiratory events as compared to propofol treatment alone ( 81 ), as well as demonstrated neuroprotective and anti-inflammatory responses in mice with toxic status epilepticus ( 84 ). However, the combination was also associated with a high incidence of tachycardia ( 85 , 86 ).…”