View source for Ketofol

==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==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Lactation risk categories|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)<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===
*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==
*[[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/>
[[Category:Pharmacology]]