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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, August 2, 2016

Propofol or Ketofol (Poker Trial)

The POKER Trial
R.E.B.E.L.EM - August 1, 2016
Procedural sedation and analgesia is a frequently performed procedure in the emergency department to help facilitate care of patients in an effective manner. Our goal should be to minimize pain and anxiety while minimizing adverse effects. We have discussed the complications associated with procedural sedation and analgesia on REBEL EM before HERE. Ketamine and Propofol are two agents commonly used for this and each agent has its own theoretical advantages and disadvantages. Due to this, it has been hypothesized that the combination of the two agents may result in fewer adverse events because of each agent counteracting the disadvantages of the other. Despite this, to date, no RCTs have really shown a reduction in adverse events with the combination of propofol and ketamine...
Author Conclusion: 
“Ketofol and propofol resulted in a similar incidence of adverse respiratory events requiring the intervention of the sedating physician. Although propofol resulted in more hypotension, the clinical relevance of this is questionable, and both agents are associated with high levels of patient satisfaction.”
Clinical Take Home Point
It appears that in adults requiring procedural sedation and analgesia, Ketofol has a similar incidence of adverse respiratory events requiring intervention when compared to propofol, but with the hypothetical addition of increased complexity of keeping track of multiple medications and syringes, that MIGHT LEAD to more medication errors (if you don’t play your cards right). At this time I would recommend folding your hand when it comes to ketofol."