Ketofol

Q: For Procedural Sedation and Analgesia (PSA), in Ketofol, "Ketamine and Propofol" are premixed in the combination of? - select one

A) 1:1 

B) 1:2

Answer: A

"Ketofol" has been used by many clinicians to get the best of both drugs and reduce the side effects of both drugs, e.g., reducing the propofol-induced hypotension and ketamine-induced vomiting and emergence reactions. The other advantage is that both drugs act synergistically. Commonly, 10 mg/mL ketamine and 10 mg/mL propofol are mixed into a 20-mL syringe. The initial dose is 0.375 to 0.5 mg/kg (0.0375 to 0.05 mL/kg of this mixture). Half of this dose can be repeated.

Although theoretically this is a great approach, studies have failed to bring any strong evidence.

#procedures

#pharmacology

References:

1. Messenger DW, Murray HE, Dungey PE, et al. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial. Acad Emerg Med 2008; 15:877.

2. Willman EV, Andolfatto G. A prospective evaluation of "ketofol" (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med 2007; 49:23.

3. Miner JR, Moore JC, Austad EJ, et al. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med 2015; 65:479.

4. Ferguson I, Bell A, Treston G, et al. Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial. Ann Emerg Med 2016; 68:574.