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Meta-Analysis
. 2020 Oct 8;20(1):81.
doi: 10.1186/s12873-020-00373-4.

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

Tze Yong Foo  1 , Norhayati Mohd Noor  2 , Mohd Boniami Yazid  3   4 , Mohd Hashairi Fauzi  1 , Shaik Farid Abdull Wahab  1 , Mohammad Zikri Ahmad  1
Affiliations
Meta-Analysis

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

Tze Yong Foo et al. BMC Emerg Med. .

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(1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches.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

Keywords: Children; Ketamine-propofol; Ketofol; Meta-analysis; Paediatric; Procedural sedation and analgesia; Systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Risk of bias graph: Review of authors’ judgments about each risk of bias item presented as percentage across all included studies
Fig. 3
Fig. 3
Risk of bias summary: Review of authors’ judgments about each risk of bias item for each included study
Fig. 4
Fig. 4
Comparison of ketofol vs. single-agent control with respect to recovery time
Fig. 5
Fig. 5
Comparison of ketofol vs. single-agent control with respect to clinician satisfaction
Fig. 6
Fig. 6
Comparison of ketofol vs. single-agent control with respect to airway obstruction
Fig. 7
Fig. 7
Comparison of ketofol vs. single-agent control with respect to apnoea
Fig. 8
Fig. 8
Comparison of ketofol vs. single-agent control with respect to desaturation
Fig. 9
Fig. 9
Comparison of ketofol vs. single-agent control with respect to nausea
Fig. 10
Fig. 10
Comparison of ketofol vs. single-agent control with respect to vomiting
Fig. 11
Fig. 11
Comparison of ketofol vs. combined agents control with respect to recovery time
Fig. 12
Fig. 12
Comparison of ketofol vs. combined agents control with respect to desaturation
Fig. 13
Fig. 13
Comparison of ketofol vs. combined agents control with respect to respiratory depression
Fig. 14
Fig. 14
Comparison of ketofol vs. combined agents control with respect to hypotension
Fig. 15
Fig. 15
Comparison of ketofol vs. combined agents control with respect to bradycardia
See this image and copyright information in PMC

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