In the above mentioned article, the authors describe a small series of patients (n= 20) ranging in age from 4-12 years undergoing bone marrow aspirations after receiving procedural sedation with a 1:1 admixture of propofol (10mg/ml) and Ketamine (10 mg/ml)[Ketofol]. The children received 0.5 mg/kg aliquots through peripheral IVs at one minute intervals until the desired sedation level was attained (Ramsey score 3-4). All of the procedures were successful. The median dose of Ketofol was 1.25 mg/kg, median recovery time 23 minutes, and a low incidence of injection site pain, emergence phenomena, and/or diplopia. No adverse airway or hemodynamic issues occurred.
This small study demonstrates the efficacy of a combination of Ketamine and Propofol mixed in one syringe to adequately sedate children for short painful procedures. Clearly the numbers are too small to make any assumptions regarding the overall safety of Ketofol. Recovery time seems to be favorable. This study does not include toddlers or teenagers for whom adverse affects may be more significant. I would caution against extrapolating the use of Ketofol for lengthy procedures when pain is a small aspect of the procedure and the need for sedation is prolonged (i.e. PICC line insertions).
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