Ketamine/Propofol Versus Midazolam/Fentanyl for Procedural Sedation and Analgesia in the Emergency Department: A Randomized, Prospective, Double-Blind Trial Publisher Pubmed



Nejati A¹ ; Moharari RS² ; Ashraf H³ ; Labaf A¹ ; Golshani K⁴
Source: Academic Emergency Medicine Published:2011

Abstract

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. © 2011 by the Society for Academic Emergency Medicine.