Procedural Sedation Using a Propofol–Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical Excision Procedure (LEEP): A Randomized Controlled Trial

Abstract

Background: Although the loop electrosurgical excision procedure (LEEP) is a brief procedure, it can cause severe pain and discomfort to patients in the absence of adequate sedation. An admixture of ketamine with propofol (ketofol), may reduce patient movement due to insufficient sedation while providing hemodynamic and respiratory stability. This study evaluated the ability of two ratios of a propofol–ketamine combination, compared with propofol alone, to reduce patient movement during procedural sedation for LEEPs. Methods: One hundred and twenty women scheduled for a LEEP were randomly assigned to three groups. Anesthesia was induced with 1 mg/kg propofol (group P), 1 mg/kg propofol and 0.33 mg/kg ketamine (group K1), or 1 mg/kg propofol and 0.66 mg/kg ketamine (group K2). The primary outcome was the incidence of adduction motion in the lower extremities during the procedure. The requirements for respiratory interventions, changes in vital signs, sedation score, additional anesthetic usage, and surgeon and patient satisfaction were also evaluated. Results: The incidence of adduction motion was significantly lower in groups K1 and K2 than in group P (overall p-value <0.001) but did not differ significantly in groups K1 and K2. Group K2 needed more jaw thrust maneuvers than group K1. Additional propofol usage was lower and surgeon satisfaction scores higher in groups K1 and K2 than in group P. Conclusion: A propofol–ketamine combination is more effective than propofol alone in reducing procedural interference during LEEPs. However, increasing the dose of ketamine showed no additional benefit.

Ketofol performance to reduce postoperative emergence agitation in children undergoing adenotonsillectomy

“…Furthermore, ketofol 1:3 blend ratio displayed an anticipated depth of sedation and abort pain impression which was due to less ketamine content in such distillation. This mixture (1:3) has been reported by Oh et al (2019) for improving sedation quality among adults who underwent loop electrosurgical excision procedure (LEEP) because it reduces procedural interference during LEEPs due to hemodynamic and respiratory stability [25]. Our outcomes are dependable with Furuya et al [26] and Lee et al [27] who proposed that the negligible change witnessed in arterial burden may be dose linked to and also as sympathomimetic actions of ketamine were effective in counter-acting the hemodynamic despair of propofol.…”

Is there any difference between oral preemptive pregabalin vs. placebo administration on response to EBUS-TBNA under sedation?

“…The undesirable effects of ketamine such as nausea and cognitive disturbance are counterbalanced by the sedative and antiemetic effects of propofol [12]. Ketamine and propofol combination is known as safe and effective for sedation [13]. Respiratory depressions are one of the most serious complications during sedation.…”

“…Respiratory depressions are one of the most serious complications during sedation. While it can happen during midazolam and propofol sedation, ketamine has lower respiratory depression incidence due to preserved airway reflexes [13,14]. The researchers applied ketofol to the patients in the emergency department, and only three patients had transient hypoxia [15].…”

The combinatorial use of propofol-fentanyl-ketamine for sedoanalgesia in patients undergoing urological procedures

“…4 Furthermore, ketofol is significantly more effective in reducing respiratory and cardiovascular complications, including hypotension and bradycardia, than propofol alone. 5 Pain management is a significant part of the perioperative patient experience in urological interventions. 6 Fentanyl is an effective opioid analgesic that is one hundred times more potent than morphine, rendering it well suited for the management of a short duration of intense pain.…”

“…In the PFK group, the median duration of induction was 2 [2][3][4] minutes, the median duration of surgery was 15 [15][16][17][18][19][20][21][22][23][24][25] minutes, and the median duration of termination was 1 [0-3] minute. The mean duration of induction, duration of surgery, and duration of termination were 5 [4][5][6][7] Upon evaluating post-induction transient O 2 desaturation, 5 (5%) patients in the PFK group had an episode of transient O 2 desaturation, compared to only one (1%) patient in the GA group (p=0.212). Furthermore, airway management was more often required for the PFK group (p<0.001), with 25 (24.8%) needing airway manipulation, of which 15 (14.9%) were resolved by jaw thrust, 4 (4%) chin lift, 2 (2%) head tilt or head repositioning, and 3 (3%) necessitated airway insertion.…”