A Prospective Evaluation of “Ketofol” (Ketamine/Propofol Combination) for Procedural Sedation and Analgesia in the Emergency Department
Received 28 April 2006; received in revised form 10 July 2006 and 27 July 2006; accepted 7 August 2006. published online 27 October 2006.
Refers to article:
Research Advances in Procedural Sedation and Analgesia
, 06 November 2006
Steven M. Green
Annals of Emergency Medicine
January 2007 (Vol. 49, Issue 1, Pages 31-36) Full Text |
Full-Text PDF (100 KB)
Study objective
We evaluate the effectiveness and consider the safety of intravenous ketamine/propofol combination (“ketofol”) in the same syringe for procedural sedation and analgesia in the emergency department (ED).
Methods
A prospective case series of consecutive ketofol procedural sedation and analgesia events in the ED of a trauma-receiving community teaching hospital from July 2005 to February 2006 was studied. Patients of all ages, with any comorbid conditions, were included. Ketofol (1:1 mixture of ketamine 10 mg/mL and propofol 10 mg/mL) was administered intravenously at the discretion of the treating physician by using titrated aliquots. The presence or absence of adverse events was documented, as were procedural success, recovery time, and physician, nurse, and patient satisfaction. Physiologic data were recorded with established hospital procedural sedation and analgesia guidelines.
Results
One hundred fourteen procedural sedation and analgesia events using ketofol were performed for primarily orthopedic procedures. The median dose of medication administered was ketamine at 0.75 mg/kg and propofol at 0.75 mg/kg (range 0.2 to 2.05 mg/kg each of propofol and ketamine; interquartile range [IQR] 0.6 to 1.0 mg/kg). Procedures were successfully performed without adjunctive sedatives in 110 (96.5%) patients. Three patients (2.6%; 95% confidence interval [CI] 0.6% to 7.5%) had transient hypoxia; of these, 1 (0.9%; 95% CI 0.02% to 4.8%) required bag-valve-mask ventilation. Four patients (3.5%; 95% CI 1.0% to 8.7%) required repositioning for airway malalignment, 4 patients (3.5%; 95% CI 1.0% to 8.7%) required adjunctive medication for sedation, and 3 patients (2.6%; 95% CI 0.6% to 7.5%) had mild unpleasant emergence, of whom 1 (0.9%; 95% CI 0.02% to 4.8%) received midazolam. No patient had hypotension or vomiting or received endotracheal intubation. Median recovery time was 15 minutes (range 5 to 45 minutes; IQR 12 to 19 minutes). Median physician, nurse, and patient satisfaction scores were 10 on a 1-to-10 scale.
Conclusion
Ketofol procedural sedation and analgesia is effective and appears to be safe for painful procedures in the ED. Few adverse events occurred and were either self-limited or responded to minimal interventions. Recoveries were rapid, and staff and patients were highly satisfied.
aUniversity of British Columbia, Vancouver, British Columbia, Canada
bEmergency Department, Lions Gate Hospital, North Vancouver, British Columbia, Canada
Address for correspondence: Gary Andolfatto, MD, Emergency Department, Lions Gate Hospital, 231 East 15th Street, North Vancouver, British Columbia V7L 2L7, Canada; 604-839-3766, fax 604-984-3526
Author contributions: EVW and GA conceived the study. EVW performed background literature review, designed the study, tabulated data, and provided statistical analyses. GA supervised conduct of trial and data collection. EVW and GA drafted article. GA takes responsibility for the paper as a whole.
Funding and support: The authors report this study did not receive any outside funding or support.
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