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Anaesth Intensive Care · Jul 2015
An audit of the haemodynamic and emergence characteristics of single-shot 'ketofol'.
A small audit showing the acceptability and absence of significant side effects of ketofol when used for brief procedural sedation (tubal ligation), particularly in the low resource setting.
Patients received a premixed ketofol dose of 0.5 mg/kg ketamine and 0.9 mg/kg propofol after fentanyl 1 mcg/kg.
Notably there was universal hemodynamic stability, although almost half of the audited patients required airway support.
summary- R F Grace, D W Tang, and E Namel.
- Senior Staff Specialist Anaesthetist, Vila Central Hospital, Port Vila, Vanuatu.
- Anaesth Intensive Care. 2015 Jul 1; 43 (4): 503-5.
Abstract'ketofol', the single-syringe combination of ketamine and propofol (50 mg of ketamine and 90 mg of propofol in a 10 ml syringe) is becoming increasingly popular for short procedures, progressively replacing the more traditional use of ketamine and diazepam in some settings. This audit examined the haemodynamic, emergence and other characteristics of ketofol administration in 42, otherwise fit, women undergoing bilateral post-partum tubal ligation at Vila Central Hospital in Vanuatu. The combination of ketamine and propofol had no clinically important adverse haemodynamic effects. Wake-up from ketofol was favourable, with low rates of nausea and minimal emergence delirium. However, 43% of patients required airway support. For short procedures such as post-partum tubal ligation in fit patients, ketofol appears to have minimal adverse haemodynamic effects and favourable emergence characteristics.
Notes
A small audit showing the acceptability and absence of significant side effects of ketofol when used for brief procedural sedation (tubal ligation), particularly in the low resource setting.
Patients received a premixed ketofol dose of 0.5 mg/kg ketamine and 0.9 mg/kg propofol after fentanyl 1 mcg/kg.
Notably there was universal hemodynamic stability, although almost half of the audited patients required airway support.
Daniel Jolley
Though has limited application outside of the low-resource setting. This basically shows ketofol is non-inferior to propofol alone, rather than superior.
The audited group is a pretty low-risk one for negative hemodynamic consequences from propofol (alone) sedation. Adding a drug (ketamine) increases technique complexity and needs to be balanced against a demonstrable benefit.
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