Ketofol: Difference between revisions
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==General== | ==General== | ||
*Type: [[Sedative agents]] | *Type: [[Sedative agents]], 1:1 mixture of [[ketamine]] and [[propofol]] | ||
*Dosage Forms: | *Dosage Forms: | ||
*Common Trade Names: | *Common Trade Names: | ||
==Adult Dosing== | ==Adult Dosing== | ||
*Starting dose: 0. | *Starting dose: 0.5mg/kg followed by another 0.5mg/kg after 30-60 seconds | ||
*Maintenance: 0. | *Maintenance: 0.25mg/kg as needed | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
| Line 22: | Line 22: | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*<3 month old (ketamine) | |||
*Known or suspected schizophrenia, even if currently stable or controlled with medications (ketamine) | |||
*Allergy to soy or eggs (propofol) | |||
*Hypotension (propofol) | |||
*Aortic stenosis (propofol) | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*[[Laryngospasm]] | |||
*Apnea or respiratory depression | |||
*Hypersalivation (rare) | |||
*Raised ICP (CPP only compromised in patients with preexisting intracranial hypertension and obstructed CSF flow)<ref>Filanovsky, Y., Philip Miller et al. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM 2010;12(2):154-7. [http://cjem-online.ca/sites/cjem-online.ca/files/pg154_0.pdf PDF]</ref> Meta-analysis also suggests that Ketamine does not increase ICP and provides favorable hemodynamics.<ref>Wang X et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014. PubMed ID: 24859931</ref> | |||
*Respiratory depression | |||
*Transient hypotension | |||
*Pain at injection site (inject lidocaine 20-40mg IV and fentanyl 50 mcg IV first) | |||
*[[Hypertriglyceridemia]] - check TG levels in ICU setting | |||
*Cardiac arrest (patients with significant cardiac disease receiving propofol for induction at highest risk) | |||
===Common=== | ===Common=== | ||
*Nausea/vomiting | |||
*Emergence reaction/agitation | |||
*Muscular hypertonicity, random movements, clonus, hiccuping | |||
*Rash | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: | ||
*Metabolism: | *Metabolism: hepatic | ||
*Excretion: | *Excretion: urine | ||
*Mechanism of Action: | *Mechanism of Action: ketamine- NMDA receptor antagonist; propofol- GABA agonist | ||
==Administration== | ==Preparation and Administration== | ||
*Ketamine | *'''[[Ketamine]]''' | ||
**Comes in a | **Comes in a 50mg/mL concentration | ||
**take a 10 mL saline flush and empty 2 mL and draw up 2 mL of ketamine | **take a 10 mL saline flush and empty 2 mL and draw up 2 mL of ketamine | ||
*** | ***100mg of ketamine in flush | ||
*Propofol | *'''[[Propofol]]''' | ||
**Comes in a standard | **Comes in a standard 10mg/mL concentration. | ||
***fill a different 10 mL syringe with this you have | ***fill a different 10 mL syringe with this you have 100mg of propofol | ||
*If you mix the two in a new 20 or 30 mL syringe you get | *If you mix the two in a new 20 or 30 mL syringe you get 100mg ketamine + 100mg propofol = 200mg total. | ||
**Every one mL has | **Every one mL has 10mg of ketofol | ||
==Comments== | ==Comments== | ||
* 2 definitions | *2 definitions | ||
**50% ketamine mixed with 50% propofol in same syringe | **50% ketamine mixed with 50% propofol in same syringe | ||
**Pretreatment with 1/2 dose ketamine, followed by propofol | **Pretreatment with 1/2 dose ketamine, followed by propofol | ||
==See Also== | ==See Also== | ||
*[[Ketamine]] | |||
*[[Propofol]] | |||
*[[Sedation (Main)]] | |||
*[[Procedural Sedation]] | |||
==External Links== | |||
*[https://www.aliem.com/ketofol-game-changer-procedural-sedation/ AliEM: Ketofol: Is this the “Game Changer” of Procedural Sedation and Analgesia?] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
Latest revision as of 20:09, 8 July 2021
General
- Type: Sedative agents, 1:1 mixture of ketamine and propofol
- Dosage Forms:
- Common Trade Names:
Adult Dosing
- Starting dose: 0.5mg/kg followed by another 0.5mg/kg after 30-60 seconds
- Maintenance: 0.25mg/kg as needed
Pediatric Dosing
Special Populations
- Pregnancy Rating:
- Lactation risk:
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
- <3 month old (ketamine)
- Known or suspected schizophrenia, even if currently stable or controlled with medications (ketamine)
- Allergy to soy or eggs (propofol)
- Hypotension (propofol)
- Aortic stenosis (propofol)
Adverse Reactions
Serious
- Laryngospasm
- Apnea or respiratory depression
- Hypersalivation (rare)
- Raised ICP (CPP only compromised in patients with preexisting intracranial hypertension and obstructed CSF flow)[1] Meta-analysis also suggests that Ketamine does not increase ICP and provides favorable hemodynamics.[2]
- Respiratory depression
- Transient hypotension
- Pain at injection site (inject lidocaine 20-40mg IV and fentanyl 50 mcg IV first)
- Hypertriglyceridemia - check TG levels in ICU setting
- Cardiac arrest (patients with significant cardiac disease receiving propofol for induction at highest risk)
Common
- Nausea/vomiting
- Emergence reaction/agitation
- Muscular hypertonicity, random movements, clonus, hiccuping
- Rash
Pharmacology
- Half-life:
- Metabolism: hepatic
- Excretion: urine
- Mechanism of Action: ketamine- NMDA receptor antagonist; propofol- GABA agonist
Preparation and Administration
- Ketamine
- Comes in a 50mg/mL concentration
- take a 10 mL saline flush and empty 2 mL and draw up 2 mL of ketamine
- 100mg of ketamine in flush
- Propofol
- Comes in a standard 10mg/mL concentration.
- fill a different 10 mL syringe with this you have 100mg of propofol
- Comes in a standard 10mg/mL concentration.
- If you mix the two in a new 20 or 30 mL syringe you get 100mg ketamine + 100mg propofol = 200mg total.
- Every one mL has 10mg of ketofol
Comments
- 2 definitions
- 50% ketamine mixed with 50% propofol in same syringe
- Pretreatment with 1/2 dose ketamine, followed by propofol
See Also
External Links
References
- ↑ Filanovsky, Y., Philip Miller et al. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM 2010;12(2):154-7. PDF
- ↑ Wang X et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014. PubMed ID: 24859931