Ketafol recipes and experience

[propadope]

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Not a big ketafol fan, personally. I think it adds cost in the form of time, med accountability issues, and (although nominal) money to the anesthetic. We recently had one of our practitioners (who has used ketafol for at least 20 years) try to "experiment" with it for outpatient colonoscopies. It was a disaster. Noticeable delays in discharge home. So much so that, the day(s) he did this, there was a collective "WTF" murmuring in the department.

Ketamine has a role in patients with a high baseline tolerance to narcotics or with extremely painful procedures... or when all else fails. I will run ketafol for big spine cases that require neurmonitoring. If the patient is just have a straight non-fusion back and a high narcotic requirement, I will give a bolus up front at the beginning of the case usually 0.25mg/kg. That's about the only time I use it.

Then again, I'm a "less is more" kind of practitioner. I also don't routinely have patients puking, confused, with intractable pain, delirious, or any other host of problems that require ongoing intervention and delay of discharge from the PACU.

I wonder what your colleague's regimen was? Ketafol (and less popular propamine) is a catchy name that
everyone loves to use, including me; but isn't really descriptive. Was there a bolus? Was there an infusion? Was there a mixture? What was the
ketamine concentration in the mixture? Etc...

I do agree that it is not the best technique for everyone and for all procedures. (No technique is) Was your colleague using ketafol with patients that have bad airways, high tolearance/chronic pain, low EF etc...?
If not then there are much better regimens for colonoscopies...