Short Attention Span Summary
Ketofol for kids?
Giving ketamine and propofol together (ketofol), each at a lower dose, has a theoretical advantage of reducing the side effects of either agent alone given at higher doses. But in this single-center, single-blinded RCT in the pediatric ED, ketamine alone had greater sedation/analgesia efficacy than ketofol. Adverse effects were similar, with more nausea in the ketamine group.
Keep it simple in kids. Ketamine/propofol had no advantage over ketamine alone for procedural sedation in pediatric patients.
Adverse Events During a Randomized Trial of Ketamine Versus Co-Administration of Ketamine and Propofol for Procedural Sedation in a Pediatric Emergency Department.
J Emerg Med. 2017 Apr 19. pii: S0736-4679(17)30238-X. doi: 10.1016/j.jemermed.2017.03.024. [Epub ahead of print]
Peer Reviewer Comments
It's interesting how much debate and subsequent literature continues to be published comparing ketamine versus ketofol. We keep getting very similar results: both are effective and not that different from each other in practice. While ketofol continues to get much publicity, I'm intrigued why nitrous oxide seems to ignored, especially given an interesting 2006 article in Pediatrics by Luhmann et al that found nitrous oxide plus hematoma block led to less pain during procedure, fewer adverse effects and a 70 minute faster recovery time compared to ketamine. I'm curious if other emergency departments have experience with nitrous oxide.