scholarly journals Ketamine-propofol (Ketofol) on Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Reference List ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

Abstract ABSTRACT Objectives This review is to evaluate 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 and MEDLINE were searched, including the reference list of related randomized control trials and reviewed articles in order to find unpublished trials or trials not identified by electronic searches. Included criteria specifically comparing recovery time, clinician satisfaction and adverse effect of ketofol. Results Eleven trials that met our criteria were included in the analysis with total 1274 patients. Five trials compared with single agent, six trials compared with combined agents. For comparison between ketofol and single agent (ketamine or propofol), ketofol shows significant effect on recovery time (MD -9.88, 95% CI: -14.30 to -5.46; P=0.0003; I 2 = 92%) but no difference when compared to combined agents (RR 0.75, 95% CI: -6.24 to 7.74; P<0.001; I 2 = 98%). In single agent comparison, ketofol show no differences in clinician satisfaction (RR 2.86, 95% CI: 0.64 to 12.69; P=0.001; I 2 = 90%), airway obstruction (RR 0.72, 95% CI: 0.35 to 11.48; P=0.81; I 2 = 0%), apnea (RR 0.9, 95% CI: 0.33 to 2.44; P=0.88; I 2 = 0%), desaturation (RR 1.11, 95% CI: 0.64 to 1.94; P=0.28; I 2 = 21%), nausea (RR 0.52, 95% CI: 0.91 to 1.41; P=0.2; I 2 = 38%) and vomiting (RR 0.63, 95% CI: 0.25 to 1.61; P=0.18; I 2 = 42%). For comparison between ketofol and combined agents, ketofol is effective in reducing hypotension (RR 4.2, 95% CI: 0.2 to 0.85; P=0.76; I 2 = 0%) but no differences in bradycardia (RR 0.70, 95% CI: 0.14 to 03.63; P=0.09; I 2 = 53%), desaturation (RR 1.9, 95% CI: 0.15 to 23.6; P=0.11; I 2 = 61%) and respiratory depression (RR 1.98, 95% CI: 0.18 to 21.94; P=0.12; I 2 = 59%). Conclusions There is low certainty evidence that ketofol improve the recovery time and reduce the frequency of hypotension with moderate certainty of evidence. No difference in other adverse effect when compared to either single or combined agents.

scholarly journals Ketamine-propofol (Ketofol) on Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Reference List ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Anesthetic Agents ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

Abstract Objectives This review is to evaluate the efficacy and side effects of ketofol in comparison to other anesthetic 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 reference list of related randomized control trials and reviewed articles to find unpublished trials or trials not identified by electronic searches. Included criteria specifically comparing recovery time, clinician satisfaction, and adverse effect of ketofol.Results Eleven trials that met our criteria were included in the analysis with total 1274 patients. Five trials compared with single agent; six trials compared with combined agents. For comparison between ketofol and single agent (ketamine or propofol), ketofol shows significant effect on recovery time (MD -9.88, 95% CI: -14.30 to -5.46; P=0.0003; I2 = 92%) but no difference when compared to combined agents (RR 0.75, 95% CI: -6.24 to 7.74; P<0.001; I2 = 98%). In single agent comparison, ketofol show no differences in clinician satisfaction (RR 2.86, 95% CI: 0.64 to 12.69; P=0.001; I2 = 90%), airway obstruction (RR 0.72, 95% CI: 0.35 to 11.48; P=0.81; I2 = 0%), apnea (RR 0.9, 95% CI: 0.33 to 2.44; P=0.88; I2 = 0%), desaturation (RR 1.11, 95% CI: 0.64 to 1.94; P=0.28; I2 = 21%), nausea (RR 0.52, 95% CI: 0.91 to 1.41; P=0.2; I2 = 38%) and vomiting (RR 0.63, 95% CI: 0.25 to 1.61; P=0.18; I2 = 42%). For comparison between ketofol and combined agents, ketofol is effective in reducing hypotension (RR 4.2, 95% CI: 0.2 to 0.85; P=0.76; I2 = 0%) but no differences in bradycardia (RR 0.70, 95% CI: 0.14 to 03.63; P=0.09; I2 = 53%), desaturation (RR 1.9, 95% CI: 0.15 to 23.6; P=0.11; I2 = 61%) and respiratory depression (RR 1.98, 95% CI: 0.18 to 21.94; P=0.12; I2 = 59%).Conclusions There is low certainty evidence that ketofol improves the recovery time and reduces the frequency of hypotension with moderate certainty of evidence. There is no difference in other adverse effects when compared to either single or combined agents.

scholarly journals Ketamine-propofol (Ketofol) for Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Significant Difference ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

Abstract 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=0.0003; I2=92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: -6.24 to 7.74; P<0.001; I2=98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P=0.001; I2=90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P=0.81; I2=0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P=0.88; I2=0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P=0.28; I2=21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P=0.2; I2=38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P=0.18; I2=42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P=0.76; I2=0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P=0.09; I2=53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P=0.11; I2=61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P=0.12; I2=59%). Conclusion There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents.Trial Registration PROSPERO CRD42019127278

scholarly journals Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Significant Difference ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

Abstract 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 = 0.0003; I2 = 92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: − 6.24 to 7.74; P < 0.001; I2 = 98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P = 0.001; I2 = 90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I2 = 0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I2 = 0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I2 = 21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P = 0.2; I2 = 38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P = 0.18; I2 = 42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P = 0.76; I2 = 0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P = 0.09; I2 = 53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P = 0.11; I2 = 61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P = 0.12; I2 = 59%). Conclusion There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents. Trial registration PROSPERO CRD42019127278.

Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis

2016 ◽  
Vol 34 (3) ◽  
pp. 558-569 ◽  
Author(s):  
Mohammad Jalili ◽  
Maryam Bahreini ◽  
Amin Doosti-Irani ◽  
Rasoul Masoomi ◽  
Mona Arbab ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Procedural Sedation ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia

scholarly journals Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 421-427 ◽  
Author(s):  
Peter J. Zed ◽  
Riyad B. Abu-Laban ◽  
Winnie W.Y. Chan ◽  
David W. Harrison
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Recovery Time ◽  
Physician Satisfaction ◽  
Procedural Sedation ◽  
Procedural Sedation And Analgesia ◽  
Standardized Protocol ◽  
Sedation And Analgesia ◽  
The Mean ◽  
Procedural Success

ABSTRACT Objective: We evaluated the efficacy, safety and patient satisfaction with the use of propofol for procedural sedation and analgesia in the emergency department (ED). Methods: All patients receiving propofol for procedural sedation and analgesia in the ED between December 1, 2003, and November 30, 2005, were prospectively assessed. Propofol was administered using a standardized protocol, which included an initial dose of 0.25–0.5 mg/kg followed by 10–20 mg/minute until sedated. Efficacy was evaluated using procedural success rate, recovery time and physician satisfaction. Adverse respiratory effects were defined as apnea for more than 30 seconds or an oxygen saturation of less than 90%. Hypotension was defined as systolic blood pressure &lt; 90 mm Hg or &gt; 20% decrease from baseline. Patient and physician satisfaction were determined using 5-point Likert scales. Results: Our study included 113 patients with a mean age of 50 (standard deviation [SD] 19) years; 62% were male. The most common procedures were orthopedic manipulation (44%), cardioversion (37%), and abscess incision and drainage (13%). The mean total propofol dose required was 1.6 (SD 0.9) mg/kg. Procedural success was achieved in 90% of cases and the mean patient recovery time was 7.6 (SD 3.4) minutes. No patient (0%, 95% confidence interval [CI] 0%–3%) experienced apnea; however, 1 patient (1%, 95% CI 0%–5%) experienced emesis, which resulted in an oxygen saturation &lt;90%. Nine patients (8%, 95% CI 4%–15%) experienced hypotension and 7 (6%, 95% CI 3%–12%) experienced pain on injection. All patients were very satisfied (92%, 95% CI 85%–96%) or satisfied (8%, 95% CI 4%–15%), and 94% (95% CI 88%–98%) reported no recollection of the procedure. The majority of physicians were very satisfied (85%, 95% CI 77%–91%) or satisfied (6%, 95% CI 3%–12%) with the sedation and the conditions achieved. Conclusion: When administered as part of a standardized protocol, propofol appears to be a safe and effective agent for performing procedural sedation and analgesia in the ED, and is associated with high patient and physician satisfaction.

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