Evidence based guideline on use of ketofol (Ketamine and Propofol admixture) for procedural sedation and analgesia (PSA) in pediatrics surgery: Review article (original) (raw)
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BMC Emergency Medicine
Objectives The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic 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MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol. Results Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: − 14.30 to − 5.46; P = 0.00...
Background Our objective was to evaluate the efficiency and tolerance of the ketamine-propofol combination for procedural sedation and analgesia in children. Patients and methods It was a prospective and observational study over 6 months involving children aged 1 to 15 years old, ASA I or II, requiring procedural sedation. The children received an initial dose of the mixture made of ketamine 0.75 mg / kg and propofol 0.75 mg / kg. Variables studied included the indication for sedation, time to sedation onset, duration of sedation, recovery time, adverse effects, tolerance of sedation, efficiency of sedation and practitioner satisfaction. Data collection was carried out using a pre-established form, with. analysis performed using Cspro version 7.4 software. Data was expressed as means, medians, and absolute numbers for quantitative variables, and as percentages for qualitative variables. Results Sedation was performed for 46 children. The median age was 3 years. The indications were painful procedures (43.5%) and imaging (34.8%). The median drug dose administered was 0.75 mg / kg of ketamine and propofol (IQR = 0.73 to 0.80 mg / kg). Sedation was adequate in all patients. Minor adverse effects were encountered in 12 children (26.1%), with 8 cases of nystagmus (17.4%) and 2 cases of agitation (4.3%). The mean sedation time was 17 ± 10.4 minutes. The median recovery time was 10 minutes (IQR = 8 to 14.3). The mean time to onset of sedation was 32.2 ± 6.9 seconds. The satisfaction scores were high. Conclusion Procedural sedation and analgesia using the ketamine-propofol combination is an interesting and effective option. It presents with minor adverse effects and recovery time is short.
Journal of Evolution of Medical and Dental Sciences, 2015
In the era of day care surgery there is growing need for the anaesthetic technique which provides stable haemodynamics, adequate analgesia, and minimal complications and at the same time rapid recovery and early ambulation. This prospective study is aimed to compare efficacy and safety of propofol with ketamine in short surgical/diagnostic procedures in paediatric age group. We randomly allocated 100 patients in to two equal groups receiving either propofol (Group I) or ketamine (Group II). It was observed that in propofol group, mean systolic and diastolic blood pressures decreased by 5.28% to 9.98% and 7.40% to 11.40% respectively, while in ketamine group mean SBP and DBP increased by 7.53% to 12.32% and 11.98% to 13.24% respectively and the difference between the two groups was statistically significant. Heart rate and respiratory rate increased in both the groups, the difference was statistically insignificant (p>0.05). Propofol has the properties of smooth induction and rapid recovery associated with transient perioperative complications which makes it an ideal intravenous anaesthetic agent for day care surgery.
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Paediatric patients usually present with various painful conditions that require immediate surgical interventions. Many studies have been done on ketamine propofol combination to prove its efficacy. Aim: The aim was to compare the effect of propofol-ketamine and propofol-fentanyl infusion in terms of haemodynamic stability, postoperative sedation, postoperative nausea and vomiting and adverse effects if any. Materials and Methods: This was a prospective, randomized, double blind controlled trial conducted in 60 patients of ASA Grade I & II of age group 3 to 14 years. Patients were randomly allocated into two groups to receive either ketamine 1mg/kg before induction (group PK, n=30) or fentanyl 1.5 ug/ kg before induction (group PF, n=30) and patients in both groups were induced with propofol 2 mg kg and maintained on propofol infusion at rate of 50 ug/ kg /min. Heart rate and blood pressure were monitored throughout the procedure. Sedation was monitored by Ramsay sedation score and side effects were noted. Results: In PF group there was a fall in heart rate as compared to PK group. There was a statistically significant fall in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in PF group (P 0.05). In PK group there is no significant fall in SBP, DBP and MAP. The patients in group PF were more sedated postoperatively and there was increased incidence of postoperative nausea and vomiting in group PF as compared to group PK. Conclusion: Propofol-ketamine combination is better as compared to propofol-fentanyl in terms of haemodynamic stability and better recovery with less side effects. Keywords: Propofol, Ketamine, Fentanyl, Paediatric procedures.
Birat Journal of Health Sciences
Introduction: Outpatient anesthesia for the minor day care surgical procedures requires a safe anesthesia and anesthetic agents. For this purpose two study solutions propofol with ketamine (ketofol) and propofol were compared. The comparison of the both agents were assessed, evaluated and discussed in this study. Methodology: This is prospective study of 100 adult patients of both sex aged between 18-60 years with ASA physical status class I and II who were operated in the Birat Medical College teaching hospital. This study was started after approval from the ethical committee of the hospital and after written and informed consent from all participants. All patients were randomly divided into two groups. Group A (n=50) received ketamine with propofol and Group B (n=50) propofol after intravenous sedation with 2 mg of midazolam and 1 mg of butorphanol. The main aim of this study was comparison of onset of sedation, respiratory and cardiac adverse events, level of sedation using Ramse...
Ketamine sedation for pediatric procedures: Part 1, a prospective series
Annals of Emergency Medicine, 1990
Emergency physicians frequently perform painful but necessary procedures on frightened children. We conducted a prospective, uncontrolled clinical trial of ketamine sedation (4 mg/kg IM) to facilitate a variety of procedures in 108 children aged 14 months to 13 years. Acceptable conditions were achieved with a single injection in 97% of the patients, and adjunctive restraint or local anesthesia was not required in 86%. Full sedation was produced within five minutes in 83%. Mean duration from injection to dischargeable recovery was 82 minutes (range, 30 to 175 minutes). One 18-month-old child vomited shortly after injection and experienced transient laryngospasm with cyanosis; intubation was not required, and there were no adverse sequelae. Airway patency and independent respirations were fully maintained in all other patients; no hemodynamic instability occurred at any time. There were no other clinically significant complications. Emesis well into the recovery phase was noted in 6% of the patients. Nightmares were not observed. Response from parents and physicians was strongly positive. Ketamine can be effectively used by emergency physicians to facilitate procedural sedation, yet equipment and expertise for advanced airway management are mandatory due to the rare occurrence of laryngospasm.
The American Journal of Emergency Medicine, 2015
This meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA). Medline, EMBASE, Scopus, CINHAL, and Cochrane Central Register of Controlled Trials were searched for clinical trial. The administration complications were the key outcomes of interest. Eighteen clinical trials that met our criteria were included in the analysis. Pooling of data showed that ketofol is significantly effective for reduction of respiratory complication and with relative risk (RR) of 0.31 in 14 trials (95% confidence interval [CI], 0.47-0.7; P = .001). Ketofol was also effective in reducing cardiovascular complications with hypotension RR of 0.11 in 9 trials (95% CI, 0.17-0.97; P = .04) and bradycardia RR of 0.47 in 8 trials (95% CI, 0.28-0.72; P = .008). The present study also showed that the summary of RR for psychomimetic complications was 1.95 in 13 trials were (95% CI, 0.79-4.81; P = .15) and for muscle rigidity was 0.52 for 2 trials (95% CI, 0.06-4.67; P = .56), and both were insignificant. In regard to nausea and vomiting, the RR was 1.23 in 12 trials (95% CI, 0.39-3.88; P = .72) and insignificant. This meta-analysis demonstrates good safety profile in cardiorespiratory problems and comparable rate of other complications with propofol in adult procedural sedation and analgesia.
Children
Background: Ketofol admixture has been proposed to be useful for sedation and general anesthesia. The beneficial effect of the combination of ketofol with lidocaine may be a shortened time of anesthesia and recovery period. This study aimed to establish the effect of total intravenous anesthesia (TIVA) with ketofol and ketofol with lidocaine on recovery in children. Methods: Two hundred children from the ages of 1–12 years who underwent short surgical procedures were randomly allocated into two groups. Propofol mixtures (ketofol) were prepared for group l. A ratio of 1:4 of ketofol was used for induction and for the maintenance of anesthesia a ratio of was used 1:7. For the induction and maintenance of anesthesia ketofol with lidocaine (lidoketofol) was used in group II. The McFarlan infusion regimen was used with reduction. The extubating time, anesthesia duration and the length of stay in the post-anesthesia care unit (PACU) were recorded. Results: Extubation time showed to be con...
Pediatric Critical Care Medicine, 2016
Objective: Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events. Design: Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium. Setting: Sedation services from academic, community, free-standing children’s hospitals and pediatric wards within general hospitals. Patients: Children from birth to 21 years old or younger. Interventions: None. Measurements and Main Results: Describe patient characteristics, procedure type, and location of administration of ketamine procedural sedation. Analyze sedation-related adverse events and severe adverse events. Identify risk factors for adverse events using multivariable logistic regression. A total of 22,645 sedations performed using ketamine...
Sedation and analgesia in children undergoing invasive procedures
Archivos argentinos de pediatría
Introduction. As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.