Ketofol

[alphaholic06]

---

Members do not see this ad.

For those of you who are using this combination for procedural sedation, how do you administer it? I've learned different ways in the last 2 years. Some attendings like to mix 100mg of ketamine and 100mg of propofol in the same syringe and give 0.5mg/kg until sedation is achieved, while others like to give a small bolus of ketamine (0.3mg/kg) and then titrate propofol to effect. What are you guys and girls doing? For those of you have used these techniques and others what works best in your experience?

 

[WilcoWorld]

I (usually) start with 0.5mg/kg of ketamine, because a) it's onset is longer and b) then they don't mind the burn of the propofol injection. Depending on how well the ketamine's done, I'll dose somewhere under or at 0.5 mg/kg of propofol. If that didn't do it, I'll give more ketamine until I have the patient where I want him. Then I give propofol 0.1 mg/kg (+/-) aliquots prn until we're done.

 

[deleted109597]

When I've done it I just mix them in the same syringe at a 50/50 mix, and push it like I would push propofol.
I don't give it very often though. For the short procedures I don't find it worth the time. If I've got a long and painful procedure I'll sometimes do it.

 

[tegs15]

I give 0.5 mg/kg of ketamine at the initial "time out" for the procedure, this gives the ketamine a few minutes (2-3) to start working. Then give 0.5 mg/kg propofol initial dose with repeat doses as needed. I don't redose the ketamine, especially in kids at night/evening, they take forever to wake up for discharge.

 

[suckstobeme]

1/2 to 3/4 dose of ketamine upfront followed by propofol boluses

 

[Direct Laryngoscopy]

do you guys/gals administer Midazolam prior to administering KEtamine? Giving Midaz prior to Ketamine has been shown to reduce the inciddence of vivid dreams (tripping) pts experience. It may also may decrease your ketafol requirements. 😴

What mixture are you using and for what proceudres?

 

[WilcoWorld]

do you guys/gals administer Midazolam prior to administering KEtamine? Giving Midaz prior to Ketamine has been shown to reduce the inciddence of vivid dreams (tripping) pts experience. It may also may decrease your ketafol requirements. 😴

What mixture are you using and for what proceudres?

I don't give midazolam if I'm using propofol with ketamine. Anecdotally, the prop takes care of the emergence reactions, so no need for midaz.

I use 10mg/ml concentrations of each, in separate syringes.

 

[RPedigo]

do you guys/gals administer Midazolam prior to administering KEtamine? Giving Midaz prior to Ketamine has been shown to reduce the inciddence of vivid dreams (tripping) pts experience. It may also may decrease your ketafol requirements. 😴

What mixture are you using and for what proceudres?

I don't, because the incidence of emergence reactions in children isn't high enough that I think it's worth it to administer prophylactic benzodiazepines. Here is the 2011 ketamine clinical practice guideline on benzo prophylaxis in children:

Coadministered Benzodiazepines

As with anticholinergics, the prophylactic coadministration of benzodiazepines has been traditionally recommended with the intent of preventing or reducing recovery reactions. A single controlled trial in ED adults found that midazolam pretreatment (0.03 mg/kg IV) significantly reduced the incidence of recovery agitation by 17% (number needed to benefit: 6). Unfortunately, this study failed to describe the nature or severity of these reactions, and so it remains unclear how many of the events were clinically important and how many were minor and transient. Nevertheless, midazolam prophylaxis appears a reasonable but nonmandatory option in adults.

In children, however, 2 controlled trials and a large meta-analysis have failed to note even a trend toward benefit from such prophylaxis. Children have far fewer recovery reactions than adults, and thus the routine pretreatment of such patients is not supported by the evidence. When unpleasant ketamine-associated recovery reactions do rarely occur, they can be rapidly and reliably diminished with titrated benzodiazepines.