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

摘要

>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 and615 were treated with ketofol. Although two of the five studies showed a better quality ofsedation with ketofol, the other three did not find any significant difference between propofoland ketofol. This systematic review found a lower incidence of respiratory adverse effects inketofol group than propofol group.>Conclusion:Ketamine/propofol mixture (ketofol) has less respiratory adverse effects thanpropofol alone in ED procedural sedation.