The authors have no relevant financial information or potential conflicts of interest to disclose.
Ketamine/Propofol Versus Midazolam/Fentanyl for Procedural Sedation and Analgesia in the Emergency Department: A Randomized, Prospective, Double-Blind Trial
Article first published online: 15 AUG 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 8, pages 800–806, August 2011
How to Cite
Nejati, A., Moharari, R. S., Ashraf, H., Labaf, A. and Golshani, K. (2011), Ketamine/Propofol Versus Midazolam/Fentanyl for Procedural Sedation and Analgesia in the Emergency Department: A Randomized, Prospective, Double-Blind Trial. Academic Emergency Medicine, 18: 800–806. doi: 10.1111/j.1553-2712.2011.01133.x
Supervising Editor: John H. Burton, MD.
- Issue published online: 15 AUG 2011
- Article first published online: 15 AUG 2011
- Received December 27, 2010; revision received March 8, 2011; accepted April 1, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:800–806 © 2011 by the Society for Academic Emergency Medicine
Objectives: The authors performed a prospective, double-blinded, randomized trial with emergency department (ED) patients requiring procedural sedation and analgesia (PSA) for repair of deep traumatic lacerations and reduction of bone fractures, to compare the ketamine/propofol (ketofol) combination with the midazolam/fentanyl (MF) combination.
Methods: Sixty-two patients scheduled for PSA who presented between January 2009 and June 2009 were enrolled prospectively. Thirty-one were randomly assigned to the ketofol group, and 31 were assigned to the MF group.
Results: The median starting doses were 0.75 mg/kg of both ketamine and propofol (interquartile range [IQR] = 0.75 to 1.5 mg/kg), 0.04 mg/kg midazolam (IQR = 0.04 to 0.06 mg/kg), and 2 μg/kg fentanyl (IQR = 2 to 3 μg/kg). There were no significant differences in sedation time between the groups. There were no differences in physician satisfaction (p = 0.065). Perceived pain in the ketofol group, as measured by the Visual Analog Scale (VAS), was significantly lower than in the MF group (median ketofol = 0, IQR = 0–1 vs. median MF = 3, IQR = 1–6; p < 0.001). Only one patient in each group required bag–mask ventilation, and neither of them were intubated.
Conclusions: The ketamine/propofol combination provides adequate sedation and analgesia for painful procedures and appears to be a safe and useful technique in the ED.