Abstract
Purpose: Ketamine-propofol combination (ketofol) is being used to provide a safe and effective procedural sedation (PS) in emergency department (ED) and may theoretically have beneficial effects since using lower doses of each drug may result in a reduction of the adverse events of both agents while maintaining optimal conditions for performing procedures. This systematic review was conducted to evaluate the efficacy, advantages and disadvantages of these two drugs for PS. Methods: The PRISMA statement was used for this systematic review. We searched the databases of PubMed, Scopus, ProQuest, Medline (Ovid) from 1990 to August 2017 for randomized clinical trials (RCTs) in which the study population aged ≥18 and was referred to ED. Full-texts of the studies performed in adults that were published in English were reviewed for inclusion. Both authors independently evaluated all studies. Five articles were eligible for the meta-analysis based on their common outcomes. Results: The total number of subjects was 1250, of which 635 were treated with propofol and 615 were treated with ketofol. Although two of the five studies showed a better quality of sedation with ketofol, the other three did not find any significant difference between propofol and ketofol. This systematic review found a lower incidence of respiratory adverse effects in ketofol group than propofol group. Conclusion:Ketamine/propofol mixture (ketofol) has less respiratory adverse effects than propofol alone in ED procedural sedation.
Highlights
Sedation is a state that the patient’s level of consciousness reduces in order to decrease irritation, nervousness and agitation.[1]
Ketamine-propofol combination is being used to provide a safe and effective procedural sedation (PS) in emergency department (ED) and may theoretically have beneficial effects since using lower doses of each drug may result in a reduction of the adverse events of both agents while maintaining optimal conditions for performing procedures
This systematic review found a lower incidence of respiratory adverse effects in ketofol group than propofol group
Summary
Sedation is a state that the patient’s level of consciousness reduces in order to decrease irritation, nervousness and agitation.[1]. Propofol with the formulation of 2, 6-diisopropylphenol is a shortacting intravenous anesthetic drug produced in 1975.6 In addition, propofol was used in the ED in 1996 for PS.[7] Propofol is a derivate of short-acting alkylphenols that is used to induce and maintain anesthesia and to sedate the patient in the procedures This feature has led propofol to be used for more than a decade and is widely used in the ED.[8] The pharmacologic mechanism of propofol is related to its agonist properties on the gamma-aminobutyric acid receptor.[9,10] The high inclination of propofol to gamma-aminobutyric acid receptors causes a remarkable pain reduction.[11] In addition, propofol suppresses sympathetic activity and inhibits the baroreceptor reflex.[12] It stimulates nitric oxide production that causes vasodilation.[13] Ketamine, a phencyclidine derivative, was first synthesized in 1962 and is commonly used for PS and analgesia and provides excellent anesthetic induction, and maintenance.[14] Ketamine causes dissociation between the cortical and limbic systems and prevents patients from perceiving sensory stimuli. It is an amnestic and analgesic agent, maintains pharyngeal reflexes, and stimulates cardiovascular tone which leads to increased
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