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

Abstract

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2019) were searched, including the reference list of related randomized control trials and reviewed articles to find unpublished trials or trials not identified by electronic searches.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.