Ketofol

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
  • Emergency 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

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