Adverse Events During a Randomized Trial of Ketamine Versus Co-Administration of Ketamine and Propofol for Procedural Sedation in a Pediatric Emergency Department

Weisz, Keith; Bajaj, Lalit; Deakyne, Sara; Brou, Lina; Brent, Alison; Wathen, Joseph; Roosevelt, Genie

doi:10.1016/j.jemermed.2017.03.024

Cited by 29 publications

(53 citation statements)

References 17 publications

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“…14,16,19−22 . For single agent comparison, three trials compared with propofol 13,15,23 , three trials compare with ketamine 17,18,23 . For combination agents, two trials compare with ketamine-dexmedetomidine 19,20 , two trials compare with propofol-dexmedetomidine 21,22 , two trials compare with propofol-fentanyl 14,16 .…”

Section: Resultsmentioning

confidence: 99%

“…All trials described the method of randomization used. Five trials randomized the participants by closed envelope method 14,16,20,22,23 ; four trials randomized the participants by computer generated method 13,17,18,21 ; one trial used the coin toss method 19 ; one trials used 1:1 block randomization with different strata based on age and type of magnetic resonance imaging (MRI) 15 . Blinding of participants and personnel were not described in four trials 13,19,22,23 .…”

Section: Resultsmentioning

confidence: 99%

“…We detected no other potential source of bias A total of 11 trials measured the primary outcome i.e. recovery time [13][14][15][16][17][18][19][20][21][22][23] . One study de ned recovery time as time in minutes required for the patient to be conscious and responding to verbal stimuli, airway recovery with return of gag re ex or cough and motor recovery as purposeful movement of limbs 21 ; another study de ned recovery time as period needed by the patient to spontaneously return to baseline consciousness 13 ; four studies used Steward Recovery Score to de ne the recovery time but with different cut off point: two studies used score of 6 20,22 while another two studies used score of 7 16,19 ; one study de ned time from discontinuation of infusion of study and achievement of Ramsey Sedation Score of 3 as recovery time 14 ; another study used Modi ed Vancouver Sedation Recovery Scale to determine the recovery time 23 .…”

Section: Resultsmentioning

confidence: 99%

“…Five trials with single agent of control group were analyzed 13,15,17,18,23 . Five trials measured recovery time, but three trials reported the results in median and interquatile range (IQR) 15,17,18 . Ketofol shows signi cant effect on recovery time compared to control (MD -9.88, 95% CI: -14.30 to -5.46; P = 0.0003; I 2 = 92%; 2 trials, 171 participants; low certainty evidence) 13,23 (Fig.…”

Section: Comparison Ketofol Vs Single Agent Controlmentioning

confidence: 99%

“…5) ( Table 2); airway obstruction compared to control (RR 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I 2 = 0%; 2 trials, 467 participants; high certainty evidence) 15,17 (Fig. 6) ( Table 2); apnea compared to control (RR 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I 2 = 0%; 2 trials, 514 participants; high certainty evidence) 15,18 (Fig. 7) ( Table 2); desaturation compared to control (RR 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I 2 = 21%; 4 trials, 771 participants; high certainty evidence) 13,15,17,18 (Fig.…”

Section: Comparison Ketofol Vs Single Agent Controlmentioning

confidence: 99%

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Ketamine-propofol (Ketofol) on Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-Analysis

Foo

Noor

Yazid

et al. 2020

Preprint

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Objectives This review is to evaluate the efficacy and side effects of ketofol in comparison to other anesthetic agents during procedural sedation and analgesia.Method The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the reference list of related randomized control trials and reviewed articles to find unpublished trials or trials not identified by electronic searches. Included criteria specifically comparing recovery time, clinician satisfaction, and adverse effect of ketofol.Results Eleven trials that met our criteria were included in the analysis with total 1274 patients. Five trials compared with single agent; six trials compared with combined agents. For comparison between ketofol and single agent (ketamine or propofol), ketofol shows significant effect on recovery time (MD -9.88, 95% CI: -14.30 to -5.46; P=0.0003; I2 = 92%) but no difference when compared to combined agents (RR 0.75, 95% CI: -6.24 to 7.74; P<0.001; I2 = 98%). In single agent comparison, ketofol show no differences in clinician satisfaction (RR 2.86, 95% CI: 0.64 to 12.69; P=0.001; I2 = 90%), airway obstruction (RR 0.72, 95% CI: 0.35 to 11.48; P=0.81; I2 = 0%), apnea (RR 0.9, 95% CI: 0.33 to 2.44; P=0.88; I2 = 0%), desaturation (RR 1.11, 95% CI: 0.64 to 1.94; P=0.28; I2 = 21%), nausea (RR 0.52, 95% CI: 0.91 to 1.41; P=0.2; I2 = 38%) and vomiting (RR 0.63, 95% CI: 0.25 to 1.61; P=0.18; I2 = 42%). For comparison between ketofol and combined agents, ketofol is effective in reducing hypotension (RR 4.2, 95% CI: 0.2 to 0.85; P=0.76; I2 = 0%) but no differences in bradycardia (RR 0.70, 95% CI: 0.14 to 03.63; P=0.09; I2 = 53%), desaturation (RR 1.9, 95% CI: 0.15 to 23.6; P=0.11; I2 = 61%) and respiratory depression (RR 1.98, 95% CI: 0.18 to 21.94; P=0.12; I2 = 59%).Conclusions There is low certainty evidence that ketofol improves the recovery time and reduces the frequency of hypotension with moderate certainty of evidence. There is no difference in other adverse effects when compared to either single or combined agents.

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