Ketofol, Propofol, or Ketamine + Propofol?

In a recent study published in Annuals of Emergency Medicine, Ketofol (1:1) vs. Propofol alone were studied for ED procedural sedation and analgesia. The two agents were compared for adverse respiratory events, induction time, and repeated dosing required to achieve sedation.  No difference was found in all categories.

In response to the study, Dr. Strayer and Dr. Shy recommended using independent dosing of Ketamine and Propofol instead of a mixture of Ketofol for the initial sedation, followed by subsequent Propofol boluses as needed near the end of a long procedure. 

Reasons:  

  1. Ketamine requires much longer monitoring than Propofol
  2. Additional doses of Ketamine to an already dissociated patient may not provide any clinical benefit

http://www.annemergmed.com/article/S0196-0644(12)00051-0/abstract

http://www.ncbi.nlm.nih.gov/pubmed/23331657