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
- 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