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Ketamine-Propofol vs. Ketamine Alone for Pediatric Procedural Sedation

Summary and Comment |
January 28, 2011

Ketamine-Propofol vs. Ketamine Alone for Pediatric Procedural Sedation

  1. Katherine Bakes, MD

Ketamine-propofol offers minimal benefits over ketamine alone.

  1. Katherine Bakes, MD

In a double-blind, randomized controlled trial, investigators compared total sedation time between a convenience sample of 67 children (age range, 2–17 years) who received ketamine-propofol and 69 who received ketamine alone for procedural sedation for reduction of an isolated extremity injury at a pediatric emergency department in Canada. The ketamine-propofol group received an intravenous bolus dose of 0.5 mg/kg ketamine and 0.5 mg/kg propofol, followed by 0.5 mg/kg propofol every 2 minutes as needed to achieve deep sedation. The ketamine-alone group received a bolus dose of 1.0 mg/kg ketamine, followed by 0.25 mg/kg ketamine every 2 minutes.

Median total sedation time (time from first drug injection to full recovery) was significantly shorter in the ketamine-propofol group than in the ketamine-alone group (13 vs. 16 minutes), as was median recovery time (time from last drug delivery to full recovery; 10 vs. 12 minutes). More patients in the ketamine-propofol group than the ketamine-alone group required multiple doses of the study medication to achieve adequate sedation (51% vs. 22%). Three patients in the ketamine-propofol group required additional nonstudy medications to complete their procedures. Vomiting was significantly less common in the ketamine-propofol group than in the ketamine-alone group (2% vs. 12%). Rates of adverse respiratory events (desaturation and obstructive apnea) were similar between groups, and all such events were corrected by either supplemental oxygen or airway repositioning. Patient, nurse, and physician satisfaction scores were significantly higher in the ketamine-propofol group.

Comment

A 3-minute difference in total sedation time is not clinically significant. The greatest benefit from ketamine-propofol seems to be a decrease in incidence of vomiting and higher provider and patient satisfaction. Either of the regimens is reasonable for pediatric procedural sedation.

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