An Analytical Comparison Between Ketamine Alone and a Combination of Ketamine and Propofol (Ketofol) for Procedural Sedation and Analgesia From an Emergency Perspective: A Systematic Review and Meta-Analysis

Abstract

Procedural sedation and analgesia (PSA) is a treatment approach involving treating patients with agents with dissociative, sedative, or analgesic properties to suppress their consciousness to variable levels. Ketamine and propofol have been used historically for PSA. Because they each have their demerits, it was postulated that combining both drugs (ketofol) would result in a mixture with additive properties and lessen or eliminate the demerits attributed to each drug. The primary objective of this systematic review and meta-analysis is to compare ketamine alone and a combination of ketamine and propofol (ketofol) for procedural sedation and analgesia from an emergency perspective. A systematic search was conducted on published studies from the databases of Scopus, ScienceDirect, PubMed, Google Scholar, APA PsycInfo, and the Cochrane Central Register of Controlled Trial (CENTRAL) until July 2022. The articles that were published on the online databases were authored between January 2007 and 2018. The selected papers were scanned and examined to check whether they met the eligibility criteria for the study. The search produced six articles that were included in the systematic review and meta-analysis. All six articles that passed the eligibility criteria were viable for the analysis. All the trials focused on the effectiveness of ketofol versus ketamine for PSA from an emergency perspective. Ketofol was found to be safe and more effective in comparison to ketamine for PTA.

Keywords: emergency medicine; ketamine; ketofol; meta-analysis; procedural sedation and analgesia; propofol; systematic review.

Figure 1. PRISMA flow diagram of the literature search results

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Forest plot comparing ketofol versus ketamine with respect to desaturation

Shah et al. (2011) [12] and Weisz et al. (2017) [13]

Figure 3. Forest plot comparing ketofol versus ketamine with respect to vomiting

Shah et al. (2011) [12] and Weisz et al. (2017) [13]

Figure 4. Forest plot comparing ketofol versus single-agent control with respect to nausea

Shah et al. (2011) [12] and Weisz et al. (2017) [13]

Figure 5. Forest plot comparing ketofol versus ketamine with respect to clinical satisfaction

Shah et al. (2011) [12] and Yalcin et al. (2018) [8]

Figure 6. Forest plot comparing ketofol versus ketamine with respect to apnea

Aboeldahab et al. (2011) [15] and Weisz et al. (2017) [13]

Figure 7. Risk of bias graph: a review of authors’ judgments about each risk of bias item presented as percentages across all included studies

Figure 8. Risk of bias summary: a review of authors’ judgments about each risk of bias item for each included study

Aboeldahab et al. (2011) [15], Andolfatto and Willman (2011) [9], Shah et al. (2011) [12], Weisz et al. (2017) [13], Willman and Andolfatto (2007) [7], and Yalcin et al. (2018) [8]