Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis

Abstract ABSTRACT Objectives This review is to evaluate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia. Method The Cochrane Central Register of Controlled Trials and MEDLINE were searched, including the reference list of related randomized control trials and reviewed articles in order to find unpublished trials or trials not identified by electronic searches. Included criteria specifically comparing recovery time, clinician satisfaction and adverse effect of ketofol. Results Eleven trials that met our criteria were included in the analysis with total 1274 patients. Five trials compared with single agent, six trials compared with combined agents. For comparison between ketofol and single agent (ketamine or propofol), ketofol shows significant effect on recovery time (MD -9.88, 95% CI: -14.30 to -5.46; P=0.0003; I 2 = 92%) but no difference when compared to combined agents (RR 0.75, 95% CI: -6.24 to 7.74; P<0.001; I 2 = 98%). In single agent comparison, ketofol show no differences in clinician satisfaction (RR 2.86, 95% CI: 0.64 to 12.69; P=0.001; I 2 = 90%), airway obstruction (RR 0.72, 95% CI: 0.35 to 11.48; P=0.81; I 2 = 0%), apnea (RR 0.9, 95% CI: 0.33 to 2.44; P=0.88; I 2 = 0%), desaturation (RR 1.11, 95% CI: 0.64 to 1.94; P=0.28; I 2 = 21%), nausea (RR 0.52, 95% CI: 0.91 to 1.41; P=0.2; I 2 = 38%) and vomiting (RR 0.63, 95% CI: 0.25 to 1.61; P=0.18; I 2 = 42%). For comparison between ketofol and combined agents, ketofol is effective in reducing hypotension (RR 4.2, 95% CI: 0.2 to 0.85; P=0.76; I 2 = 0%) but no differences in bradycardia (RR 0.70, 95% CI: 0.14 to 03.63; P=0.09; I 2 = 53%), desaturation (RR 1.9, 95% CI: 0.15 to 23.6; P=0.11; I 2 = 61%) and respiratory depression (RR 1.98, 95% CI: 0.18 to 21.94; P=0.12; I 2 = 59%). Conclusions There is low certainty evidence that ketofol improve the recovery time and reduce the frequency of hypotension with moderate certainty of evidence. No difference in other adverse effect when compared to either single or combined agents.

Download Full-text

Ketamine-propofol (Ketofol) for Procedural Sedation and Analgesia in Children: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-40377/v3 ◽

2020 ◽

Author(s):

Tze Yong Foo ◽

Norhayati Mohd Noor ◽

Mohd Boniami Yazid ◽

Mohd Hashairi Fauzi ◽

Shaik Farid Abdull Wahab ◽

...

Keyword(s):

Adverse Effects ◽

Recovery Time ◽

Meta Analysis ◽

Single Agent ◽

Procedural Sedation ◽

Cochrane Central Register ◽

Procedural Sedation And Analgesia ◽

Significant Difference ◽

Clinician Satisfaction ◽

Sedation And Analgesia

Abstract Objectives The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia. Method The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol. Results Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: -14.30 to -5.46; P=0.0003; I2=92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: -6.24 to 7.74; P<0.001; I2=98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P=0.001; I2=90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P=0.81; I2=0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P=0.88; I2=0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P=0.28; I2=21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P=0.2; I2=38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P=0.18; I2=42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P=0.76; I2=0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P=0.09; I2=53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P=0.11; I2=61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P=0.12; I2=59%). Conclusion There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents.Trial Registration PROSPERO CRD42019127278

Download Full-text

Intranasal ketamine for procedural sedation and analgesia in children: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0173253 ◽

2017 ◽

Vol 12 (3) ◽

pp. e0173253 ◽

Cited By ~ 14

Author(s):

Naveen Poonai ◽

Kyle Canton ◽

Samina Ali ◽

Shawn Hendrikx ◽

Amit Shah ◽

...

Keyword(s):

Systematic Review ◽

Procedural Sedation ◽

Procedural Sedation And Analgesia ◽

Sedation And Analgesia

Download Full-text

Intranasal Ketamine for Procedural Sedation and Analgesia in Children: A Systematic Review

10.1542/peds.141.1_meetingabstract.350 ◽

2018 ◽

Author(s):

Kyle R. Canton ◽

Shawn Hendrikx ◽

Gary Joubert ◽

Amit Shah ◽

Michael Rieder ◽

...

Keyword(s):

Systematic Review ◽

Procedural Sedation ◽

Procedural Sedation And Analgesia ◽

Sedation And Analgesia

Download Full-text

A meta-analysis of randomized controlled trials: combination of ketamine and propofol versus ketamine alone for procedural sedation and analgesia in children

Internal and Emergency Medicine ◽

10.1007/s11739-019-02173-6 ◽

2019 ◽

Vol 14 (7) ◽

pp. 1159-1165 ◽

Cited By ~ 3

Author(s):

Yaofei Hu ◽

Wujie Xu ◽

Fei Cao

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Procedural Sedation ◽

Controlled Trials ◽

Procedural Sedation And Analgesia ◽

Randomized Controlled ◽

Sedation And Analgesia

Download Full-text

Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis

BMC Emergency Medicine ◽

10.1186/s12873-020-00373-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tze Yong Foo ◽

Norhayati Mohd Noor ◽

Mohd Boniami Yazid ◽

Mohd Hashairi Fauzi ◽

Shaik Farid Abdull Wahab ◽

...

Keyword(s):

Adverse Effects ◽

Recovery Time ◽

Meta Analysis ◽

Single Agent ◽

Procedural Sedation ◽

Cochrane Central Register ◽

Procedural Sedation And Analgesia ◽

Significant Difference ◽

Clinician Satisfaction ◽

Sedation And Analgesia

Abstract Objectives The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia. Method The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol. Results Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: − 14.30 to − 5.46; P = 0.0003; I2 = 92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: − 6.24 to 7.74; P < 0.001; I2 = 98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P = 0.001; I2 = 90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I2 = 0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I2 = 0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I2 = 21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P = 0.2; I2 = 38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P = 0.18; I2 = 42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P = 0.76; I2 = 0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P = 0.09; I2 = 53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P = 0.11; I2 = 61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P = 0.12; I2 = 59%). Conclusion There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents. Trial registration PROSPERO CRD42019127278.

Download Full-text

Midazolam, Etomidate, Propofol, Fentanyl, Ketamine, and Propofol/Ketamine for Procedural Sedation and Analgesia Among Adults in the Emergency Departments: A Systematic Review

Shiraz E-Medical Journal ◽

10.5812/semj.96024 ◽

2020 ◽

Vol 21 (9) ◽

Author(s):

Maryam Massaeli ◽

Soheil Nasouhi ◽

Afshin Motallebzadeh ◽

Masoud Shahabian

Keyword(s):

Systematic Review ◽

Emergency Departments ◽

Procedural Sedation ◽

Procedural Sedation And Analgesia ◽

Randomized Controlled Clinical Trials ◽

Current Systematic Review ◽

Sedation And Analgesia ◽

The Subject ◽

Hospital Protocols ◽

Recovery Of Consciousness

: The current systematic review aimed at investigating different medications commonly used for procedural sedation and analgesia (PSA) in emergency departments (EDs) for adults. The articles related to the subject of interest were searched in five electronic databases, including Google Scholar, PubMed, Medline, Web of Science, Scopus, and Embase, up to 2019. The blinded, randomized, controlled, clinical trials comparing common PSA medications, including midazolam, etomidate, propofol, fentanyl, ketamine, and ketofol, among the adults undergoing PSA in EDs were included in the study. The search process resulted in the inclusion of 35 papers in the study. The main information, including clinical features, sedation duration, recovery time, and incidence of adverse events, was extracted from the selected studies. Based on the reviewed studies, various combinations of medications are used for PSA depending on the hospital protocols and policies; however, there is still controversy over the best choice. As the results of the retrieved articles indicated, propofol is the most common medication used for PSA in EDs due to the shorter time of induction, rapid recovery of consciousness, and fewer side effects. Etomidate and ketamine were also identified as other common sedatives applied for PSA.

Download Full-text