Evidence based guideline on use of ketofol (Ketamine and Propofol admixture) for procedural sedation and analgesia (PSA) in pediatrics surgery: Review article

• Published in: International journal of surgery open Vol. 25; pp. 52 - 58
• Main Authors: Ali, Siraj Ahmed, Aweke, Zemedu, Jemal, Bedru
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 2020
• Subjects: Analgesia; Ketofol; Pediatrics; Sedation; Analgesia; Pediatrics; Sedation; Ketofol
• ISSN: 2405-8572; 2405-8572
• DOI: 10.1016/j.ijso.2020.06.008

Procedural sedation and analgesia (PSA) implies the state of drug induced tolerance of uncomfortable or painful diagnostic, interventional medical and surgical procedures. Ketofol (ketamine and Propofol mixture) is a good combination of drugs for PSA in painful procedures in pediatrics resulting in hemodynamic and respiratory safety. A combination of these drugs provides sedation, analgesia, and rapid recovery with hemodynamic stability and minimal respiratory depression. The objective of sedation during such procedures is to reduce the discomfort of the patient and to facilitate the performance of the procedure.
This systematic review was conducted according to the preferred reporting items for systematic review and meta-analysis protocol (PRISMA). Evidences for this guideline development were searched from PubMed, Google Scholar, Google search, and Medline databases with keywords.
During the review of searched literature for the guideline, important concerns discussed were patient selection and assessment (indication for PSA), monitoring of children including depth of sedation, medication administration (a combination of the agents), and criteria for postoperative discharge.
Generally, in the presence of adequate resuscitation equipment and monitoring ketamine and Propofol mixture can be used in the proportion of 1:1, 1:2, 1:3, and 1:4 safely with good respiratory and hemodynamic stability.
•Ketamine and Propofol in a proportion of 1:1, 1:2, 1:3, or 1:4 can be usedin PSA for pediatrics.•Use the ASA standards for basic anesthetic monitoring is recommended.•Level of sedation should be assessed with clinical observations using the Modified RAMAY Sedation Scale.•PACU discharge must be after 30 min following last administration sedative medication.