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

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MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches.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

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

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.

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

2020 ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Reference List ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

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.

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

2020 ◽  
Author(s):  
Tze Yong Foo ◽  
Norhayati Mohd Noor ◽  
Mohd Boniami Yazid ◽  
Mohd Hashairi Fauzi ◽  
Shaik Farid Abdull Wahab ◽  
...  
Keyword(s):  
Recovery Time ◽  
Meta Analysis ◽  
Single Agent ◽  
Procedural Sedation ◽  
Reference List ◽  
Cochrane Central Register ◽  
Procedural Sedation And Analgesia ◽  
Anesthetic Agents ◽  
Clinician Satisfaction ◽  
Sedation And Analgesia

Abstract Objectives This review is to evaluate the efficacy and side effects of ketofol in comparison to other anesthetic 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 reference list of related randomized control trials and reviewed articles 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; I2 = 92%) but no difference when compared to combined agents (RR 0.75, 95% CI: -6.24 to 7.74; P<0.001; I2 = 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; I2 = 90%), airway obstruction (RR 0.72, 95% CI: 0.35 to 11.48; P=0.81; I2 = 0%), apnea (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%). 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; I2 = 0%) but no differences in 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%).Conclusions There is low certainty evidence that ketofol improves the recovery time and reduces the frequency of hypotension with moderate certainty of evidence. There is no difference in other adverse effects when compared to either single or combined agents.

scholarly journals Comparison of inhaled methoxyflurane versus procedural sedation for manipulation and reduction of acute shoulder and elbow dislocation in the emergency department

2021 ◽  
pp. 201010582199349
Author(s):  
Shu Fang Ho ◽  
Sameera Ganti ◽  
Eunizar Omar ◽  
Sherman Wei Qiang Lian ◽  
Hui Cheng Tan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Shoulder Dislocation ◽  
Elbow Dislocation ◽  
Procedural Sedation ◽  
Median Length ◽  
Procedural Sedation And Analgesia ◽  
Significant Difference ◽  
Sedation And Analgesia ◽  
Secondary Outcomes

Introduction: This paper compares the usage of inhaled methoxyflurane versus traditional procedural sedation and analgesia for manipulation and reduction of acute shoulder dislocation and acute elbow dislocation in the emergency department. Methods: This was a retrospective observational study of patients who presented with either acute shoulder dislocation or acute elbow dislocation to an adult tertiary emergency department between 1 April 2018 and 30 September 2019 and underwent manipulation and reduction with either methoxyflurane or procedural sedation and analgesia. Primary outcomes of patients’ length of stay in the emergency department and secondary outcomes of duration of procedure and success of reduction on first attempt for inhaled methoxyflurane were compared against those of procedural sedation and analgesia. Results: A total of 192 patients were included in this study; 74 patients underwent reduction with methoxyflurane while 118 patients (85 acute shoulder dislocation and 33 acute elbow dislocation) underwent reduction with procedural sedation and analgesia. The median length of stay in the emergency department was significantly shorter ( P<0.001) for the methoxyflurane group (99 minutes, interquartile range (IQR) 136.8 minutes) versus the procedural sedation and analgesia group (246.5 minutes, IQR 163 minutes). The median duration of procedure in the emergency department was also significantly shorter ( P<0.001) for the methoxyflurane group (16 minutes, IQR 17 minutes) versus the procedural sedation and analgesia group (32 minutes, IQR 40.3 minutes). There was no significant difference in reduction on first attempt between the two groups. Conclusion: The use of inhaled methoxyflurane in the manipulation and reduction of acute shoulder dislocation and acute elbow dislocation was associated with a shorter patient length of stay and a shorter duration of procedure, while no significant difference was observed in the success of reduction on first attempt when compared to procedural sedation and analgesia.

scholarly journals Hydroxychloroquine for Treatment of COVID‐19 Patients: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Vinícius Y Moraes ◽  
Alexandre R Marra ◽  
Leandro L Matos ◽  
Ary Serpa Neto ◽  
Luiz Vicente Rizzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Control Group ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Random Effects Models ◽  
Significant Difference

Abstract Background: We performed a systematic review of the literature and meta-analysis on the efficacy and safety of hydroxychloroquine to treat coronavirus disease 2019 (COVID-19) patients. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS (2019 to March 2021) for patients aged 18 years or older, who had COVID-19 and were treated with hydroxychloroquine versus placebo or standard of care. We also searched the WHO Clinical Trials Registry for ongoing and recently completed studies, and the reference lists of selected articles and reviews for possible relevant studies, with no restrictions regarding language or publication status. Random-effects models were used to obtain pooled mean differences of treatment effect on mortality, and serious adverse effects between hydroxychloroquine (HCQ) and the control group (standard of care or placebo); heterogeneity was assessed using the I2 and the Cochran´s Q statistic. Results: Nine studies met the inclusion criteria and were included in the meta-analysis. There was no significant difference in mortality rate between patients treated with HCQ compared to standard of care or placebo (16.7% vs. 18.5%; pooled risk ratio 1.09; 95%CI: 0.99-1.19). Also, therate of serious adverse effects was similar between both groups, HCQ and control (3.7% vs. 2.9%; pooled risk ratio 1.22; 95%CI: 0.76-1.96). Conclusion: Hydroxychloroquine is not efficacious in reducing mortality of COVID-19 patients.Systematic review registration: Prospero database, registration number: CRD42020197070.

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

CJEM ◽  
2006 ◽  
Vol 8 (02) ◽  
pp. 85-93 ◽  
Author(s):  
Sam G. Campbell ◽  
Kirk D. Magee ◽  
George J. Kovacs ◽  
David A. Petrie ◽  
John M. Tallon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Hospital ◽  
Procedural Sedation ◽  
Procedural Sedation And Analgesia ◽  
Patterns Of Use ◽  
Significant Difference ◽  
Sedation And Analgesia ◽  
Pharmacologic Agents

ABSTRACTObjectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital.Methods:Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period.Results:Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%–2.3%), and desaturation (Sao2≤ 90) in 14 of 979 (1.4%; CI 0.1%–2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs.Conclusions:Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

scholarly journals Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Morteza Ghojazadeh ◽  
Sarvin Sanaie ◽  
Seyed Pouya Paknezhad ◽  
Sahba-Sadat Faghih ◽  
Hassan Soleimanpour
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Adverse Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Procedural Sedation ◽  
Beneficial Effects ◽  
Advantages And Disadvantages ◽  
Significant Difference ◽  
Study Population

Purpose: Ketamine-propofol combination (ketofol) is being used to provide a safe and effective procedural sedation (PS) in emergency department (ED) and may theoretically have beneficial effects since using lower doses of each drug may result in a reduction of the adverse events of both agents while maintaining optimal conditions for performing procedures. This systematic review was conducted to evaluate the efficacy, advantages and disadvantages of these two drugs for PS. Methods: The PRISMA statement was used for this systematic review. We searched the databases of PubMed, Scopus, ProQuest, Medline (Ovid) from 1990 to August 2017 for randomized clinical trials (RCTs) in which the study population aged ≥18 and was referred to ED. Full-texts of the studies performed in adults that were published in English were reviewed for inclusion. Both authors independently evaluated all studies. Five articles were eligible for the meta-analysis based on their common outcomes. Results: The total number of subjects was 1250, of which 635 were treated with propofol and 615 were treated with ketofol. Although two of the five studies showed a better quality of sedation with ketofol, the other three did not find any significant difference between propofol and ketofol. This systematic review found a lower incidence of respiratory adverse effects in ketofol group than propofol group. Conclusion: Ketamine/propofol mixture (ketofol) has less respiratory adverse effects than propofol alone in ED procedural sedation.

Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis

2016 ◽  
Vol 34 (3) ◽  
pp. 558-569 ◽  
Author(s):  
Mohammad Jalili ◽  
Maryam Bahreini ◽  
Amin Doosti-Irani ◽  
Rasoul Masoomi ◽  
Mona Arbab ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Procedural Sedation ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia
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