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: 0.5 mg/kg followed by another 0.5 mg/kg after 30-60 seconds
*Starting dose: 0.5mg/kg followed by another 0.5mg/kg after 30-60 seconds
*Maintenance: 0.25 mg/kg as needed
*Maintenance: 0.25mg/kg as needed


==Pediatric Dosing==
==Pediatric Dosing==
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==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
 
==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
*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==
==Comments==
*2 definitions
**50% ketamine mixed with 50% propofol in same syringe
**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:Drugs]]
[[Category:Pharmacology]]
 
* 2 definitions
**1. 50% ketamine mixed with 50% propofol in same syringe
**2. Pretreatment with 1/2 dose ketamine, followed by propofol
*Ketamine comes in a 50 mg/mL concentration
*take a 10 mL saline flush and empty 2 mL and draw up 2 mL of ketamine
**100 mg of ketamine in flush
<br>
*Propofol comes in a standard 10 mg/mL concentration.
*fill a different 10 mL syringe with this you have 100 mg of propofol
 
*If you mix the two in a new 20 or 30 mL syringe you get 100 mg ketamine + 100 mg propofol = 200 mg total.
*Every one mL has 10 mg of ketofol.

Latest revision as of 20:09, 8 July 2021

General

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

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
  • 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

  1. ↑ 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
  2. ↑ 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
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