Ketofol [ketamine/propofol]for pediatric orthopedic emergencies

ABSTRACT

Emergency management of pediatric fractures and dislocations re-quires effective analgesia, yet children's pain is often undertreated. Wecompared the safety and efficacy of intravenous ketamine / propofolcombination ["ketofol"] in the same syringe versus ketamine / midazolam[K/M] for procedural sedation and analgesia in the emergency depart-ment. Sixty patients between 5 and 12 years of age, [ASA] class I or IIwere randomly allocated into two equal groups Ketofol group and K/Mgroup. The presence or absence of adverse events was documented, aswere procedural success, induction time, recovery time and total se-dation time. Physiologic data were recorded with established hospitalprocedural sedation and analgesia guidelines. The induction, recoverytimes were shorter in Ketofol group than in [K/M] group, respectively[P< .05] while total sedation time was very highly significant[P<0.001]. As regard to deep sedation, complete amnesia and Success-ful reduction there was no significance difference between ketofol and[K/M] groups. Vomiting occurred in two patients during procedure in [K/M] group [very high significant difference P<0.0001] while during recoveryit occurred in two patients in Ketofol group and four patients in [K/M]group [no significance difference]. We conclude that during emergencyorthopedic fractures, intravenous ketofol [ketamine / propofol] and thecombination of ketamine and midazolam provides safe, effective seda-tion for procedures in children. Both regimens are effective in facilitatingfracture reduction and both produce amnesia in nearly all children,but average time required for recovery is longer for ketamine / midazo-lam than for ketofol