Adverse Events With Ketamine Versus Ketofol for Procedural Sedation on Adults: A Double‐blind, Randomized Controlled Trial

Abstract

We found a significant reduction in recovery reactions and emesis frequencies among adult patients receiving emergency procedural sedations with ketofol, compared with ketamine.

Ketamine or Ketofol: Do We Have Enough Evidence to Know Which One to Use?

“…In terms of cardiovascular effects, however, we have seen differences in the agents, and it appears that ketamine causes less hypotension than propofol . This has also been found for ketofol .…”

“…The other difference studies consistently find between ketamine, ketofol, and propofol is recovery agitation. This is variably defined in studies, but it appears that this event is very rare for propofol and less common with ketofol but occurs in 10% to 30% of ketamine sedations . Since we know that propofol is more associated with hypotension than ketofol or ketamine, the difference in recovery agitation may be an important differentiator between ketamine and ketofol.…”

“…In the absence of improved accuracy and precision of the measurements we use in clinical trials, we are left to interpret what we have when we select an agent. In this issue of Academic Emergency Medicine, Lemoel et al . took a slightly different approach to sedation research and compared ketamine to ketofol for procedural sedation in adults using recovery reactions as the primary outcome rather than the more typical measures of respiratory depression or cardiovascular function.…”

“…We have also seen very strong opinions regarding propofol's lack of analgesic properties and that since ketamine is an analgesic, it will be better for sedation, but this does not pan out in research. Recalled pain, satisfaction, and postprocedure pain are typically reported as the same between these agents . Even a small study of catecholamine levels did not detect a difference in stress levels for patients treated with and without an opioid added to propofol .…”

“…The study in this issue of Academic Emergency Medicine by Lemoel et al . asks the question of what is the difference in recovery agitation between ketofol and ketamine, to give us an idea of the effect of ketofol relative to ketamine and allow us to decide to use it or not.…”