Ketamine-Propofol Combination (Ketofol) Versus Propofol Alone for Emergency Department Procedural Sedation and Analgesia: A Randomized Double-Blind Trial

Andolfatto, Gary; Abu‐Laban, Riyad B.; Zed, Peter J.; Staniforth, Sean M.; Stackhouse, Sherry; Moadebi, Susanne; Willman, Elaine

doi:10.1016/j.annemergmed.2012.01.017

Cited by 128 publications

(119 citation statements)

References 41 publications

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“…1,19,22 Five studies reported the frequency of adverse respiratory events (Table 1). 1,[18][19][20]22 Andolfatto et al 19 reported this outcome according to the Quebec Criteria, which provide standardized, intervention-based definitions for adverse event reporting in PSA research. Definitions for adverse respiratory events as reported by each included study are outlined in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two of the studies included only adult patients, 1,18 and two included both adult and pediatric patients (one excluded age < 14 years and one included age ≥ 2 years). 19,20 The trial by Del Pizzo et al 21 included pediatric patients aged 3 to 18 years, and the patient population was unclear in one trial. 22 The majority of procedures performed were orthopedic in nature (>65%), followed by abscess drainage (>20%).…”

Section: Resultsmentioning

confidence: 99%

“…1,[18][19][20][21][22] Percent agreement for final selection of included trials was 95.2%, with very good inter-rater agreement (j = 0.88; 95% CI = 0.68 to 1.0).…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies were published journal articles, 1,[18][19][20] and two were peer-reviewed abstracts selected for presentation at national and international conferences. 21,22 Two of the included studies were randomized, blinded, three-arm clinical trials of patients undergoing procedural sedation in the ED.…”

Section: Resultsmentioning

confidence: 99%

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Ketamine‐Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Yan

McLeod

Iansavichene

2015

Academic Emergency Medicine

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Objectives: Propofol is an agent commonly used for procedural sedation and analgesia (PSA) in the emergency department (ED), but it can cause respiratory depression and hypotension. The combination of ketamine-propofol (K-P) is an alternative that theoretically provides a reduction in adverse events compared to propofol. The primary objective of this review was to determine if K-P has a lower frequency of adverse respiratory events in patients undergoing PSA in the ED than propofol alone. Secondary objectives were to compare the proportion of overall adverse events, sedation time, procedure time, and recovery time between K-P and propofol.Methods: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) published in English comparing the use of K-P to propofol alone for PSA in the ED were included.Results: Six RCTs were included with a combined total of 932 patients (K-P = 520, propofol = 412). Five RCTs reported the proportion of adverse respiratory events; the pooled estimate revealed fewer adverse respiratory events with K-P compared to propofol (29.0% vs. 35.4%; risk ratio [RR] = 0.82; 95% confidence interval [CI] = 0.68 to 0.99). There was no significant difference with respect to the proportion of overall adverse events (38.8% vs. 42.5%; RR = 0.88; 95% CI = 0.75 to 1.04). Procedure time was similar when the groups were compared. Conclusions:The premise of combining ketamine with propofol is based on the many synergies that theoretically exist between these two agents. In this study, K-P had a lower frequency of adverse respiratory events in patients undergoing PSA in the ED compared to propofol alone.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…1,[18][19][20][21][22] Percent agreement for final selection of included trials was 95.2%, with very good inter-rater agreement (j = 0.88; 95% CI = 0.68 to 1.0).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Ketamine‐Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Yan

McLeod

Iansavichene

2015

Academic Emergency Medicine

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“…5 Administering ketamine and propofol mixed in the same syringe (ketofol) has been shown to be efficacious in the operating room, ambulatory settings and emergency departments. 6,7 Various combinations of propofol and ketofol have been described in the provision of procedural sedation in adults and children. This study was designed to evaluate the use of ketofol "ketamine/propofol mixtures" in two different ratios (1:3 and 1:5) for sedation and analgesia for Intrathecal injection of chemotherapy drugs in leukemic children.…”

Section: Introductionmentioning

confidence: 99%

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

et al. 2015

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Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children

et al. 2017

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IMPORTANCE Procedural sedation for children undergoing painful procedures is standard practice in emergency departments worldwide. Previous studies of emergency department sedation are limited by their single-center design and are underpowered to identify risk factors for serious adverse events (SAEs), thereby limiting their influence on sedation practice and patient outcomes.OBJECTIVE To examine the incidence and risk factors associated with sedation-related SAEs.DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter, observational cohort study was conducted in 6 pediatric emergency departments in Canada between July 10, 2010, and February 28, 2015. Children 18 years or younger who received sedation for a painful emergency department procedure were enrolled in the study. Of the 9657 patients eligible for inclusion, 6760 (70.0%) were enrolled and 6295 (65.1%) were included in the final analysis.EXPOSURES The primary risk factor was receipt of sedation medication. The secondary risk factors were demographic characteristics, preprocedural medications and fasting status, current or underlying health risks, and procedure type. MAIN OUTCOMES AND MEASURESFour outcomes were examined: SAEs, significant interventions performed in response to an adverse event, oxygen desaturation, and vomiting. RESULTSOf the 6295 children included in this study, 4190 (66.6%) were male and the mean (SD) age was 8.0 (4.6) years. Adverse events occurred in 736 patients (11.7%; 95% CI, 6.4%-16.9%). Oxygen desaturation (353 patients [5.6%]) and vomiting (328 [5.2%]) were the most common of these adverse events. There were 69 SAEs (1.1%; 95% CI, 0.5%-1.7%), and 86 patients (1.4%; 95% CI, 0.7%-2.1%) had a significant intervention. Use of ketamine hydrochloride alone resulted in the lowest incidence of SAEs (17 [0.4%]) and significant interventions (37 [0.9%]). The incidence of adverse sedation outcomes varied significantly with the type of sedation medication. Compared with ketamine alone, propofol alone (3.7%; odds ratio [OR], 5.6; 95% CI, 2.3-13.1) and the combinations of ketamine and fentanyl citrate (3.2%; OR, 6.5; 95% CI, 2.5-15.2) and ketamine and propofol (2.1%; OR, 4.4; 95% CI, 2.3-8.7) had the highest incidence of SAEs. The combinations of ketamine and fentanyl (4.1%; OR, 4.0; 95% CI, 1.8-8.1) and ketamine and propofol (2.5%; OR, 2.2; 95% CI, 1.2-3.8) had the highest incidence of significant interventions. CONCLUSIONS AND RELEVANCEThe incidence of adverse sedation outcomes varied significantly with type of sedation medication. Use of ketamine only was associated with the best outcomes, resulting in significantly fewer SAEs and interventions than ketamine combined with propofol or fentanyl.

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Ketamine-Propofol Combination (Ketofol) Versus Propofol Alone for Emergency Department Procedural Sedation and Analgesia: A Randomized Double-Blind Trial

Cited by 128 publications

References 41 publications

Ketamine‐Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Ketamine‐Propofol Versus Propofol Alone for Procedural Sedation in the Emergency Department: A Systematic Review and Meta‐analysis

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children

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