Ketofol: Difference between revisions
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Laryngospasm | *[[Laryngospasm]] | ||
*Apnea or respiratory depression | *Apnea or respiratory depression | ||
*Hypersalivation (rare) | *Hypersalivation (rare) | ||
| Line 42: | Line 42: | ||
===Common=== | ===Common=== | ||
*Nausea/vomiting | *Nausea/vomiting | ||
* | *Emergence reaction/agitation | ||
*Muscular hypertonicity, random movements, clonus, hiccuping | *Muscular hypertonicity, random movements, clonus, hiccuping | ||
*Rash | *Rash | ||
| Line 73: | Line 73: | ||
*[[Sedation (Main)]] | *[[Sedation (Main)]] | ||
*[[Procedural Sedation]] | *[[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:Pharmacology]] | [[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