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

Morteza Ghojazadeh ¹ , Sarvin Sanaie ² , Seyed Pouya Paknezhad ³ , Sahba-Sadat Faghih ⁴ , Hassan Soleimanpour ⁵ *

Cited by CrossRef: 38

1- Cappellini I, Bavestrello Piccini G, Campagnola L, Bochicchio C, Carente R, Lai F, Magazzini S, Consales G. Procedural Sedation in Emergency Department: A Narrative Review. Emergency Care and Medicine. 2024;1(2):103 [Crossref]

2- Oh C, Kim Y, Eom H, Youn S, Lee S, Ko Y, Yoo H, Chung W, Lim C, Hong B. Procedural Sedation Using a Propofol–Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical Excision Procedure (LEEP): A Randomized Controlled Trial. JCM. 2019;8(7):943 [Crossref]

3- Ayan M, Ozsoy O, Ozbay S, Akman C, Suzer N, Karcioglu O. Procedural (Conscious) Sedation and Analgesia in Emergency Setting: How to Choose Agents?. CPD. 2023;29(28):2229 [Crossref]

4- Wang Y, Sun Y, Hu Y, Xiao Z. Bibliometric Analysis of Anesthetic Drugs’ Effects on Immune Function- Current Knowledge, Hotspots and Future Perspectives. DDDT. 2023;Volume 17:3219 [Crossref]

5- Tarwade P, Smischney N. Endotracheal intubation sedation in the intensive care unit. WJCCM. 2022;11(1):33 [Crossref]

6- Padhi P, Yeeda S, Nayak L, Das S. Procedural Sedation Using Two Different Proportions of Ketamine-Propofol Combination in Short Gynecological Procedures: A Randomized Controlled Trial. 2022; [Crossref]

7- Zarei M, Hajipoor Kashgsaray N, Asheghi M, Shahabifard H, Soleimanpour H. Non-opioid Intravenous Drugs for Pain Management in Patients Presenting with Acute Migraine Pain in the Emergency Department: A Comprehensive Literature Review. Anesth Pain Med. 2022;12(5) [Crossref]

8- Lorenzati B, Abram S, Giamello J, Bruno A, Gambardella L, Lison D, D'Agnano S, Martini G, Sciolla A, Lauria G. Procedural sedation and analgesia by Italian emergency physicians: a retrospective observational pilot study. Emerg Care J. 2024; [Crossref]

9- Fukano K, Iizuka Y, Ueda T, Fukuda Y, Otsuka Y, Sanui M. Comparison of Sedation With Ketamine-Propofol Versus Propofol-Fentanyl for Elderly Patients Undergoing Prostate Biopsy: A Retrospective Observational Study. 2023; [Crossref]

10- Xiao S, Zhou Y, Wang Q, Yang D. Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model. DDDT. 2022;Volume 16:4411 [Crossref]

11- Azizkhani R, Kouhestani S, Heydari F, Majidinejad S. A comparative study of dexmedetomidine and propofol to prevent recovery agitation in adults undergoing procedural sedation with ketamine: A randomized double-blind clinical trial. The American Journal of Emergency Medicine. 2021;50:167 [Crossref]

12- Hung K, Chen J, Wu S, Huang P, Wu J, Liu T, Liu C, Chen I, Sun C. A systematic review and meta-analysis comparing the efficacy and safety of ciprofol (HSK3486) versus propofol for anesthetic induction and non-ICU sedation. Front Pharmacol. 2023;14 [Crossref]

13- Pouraghaei M, Moharamzadeh P, Paknezhad S, Rajabpour Z, Soleimanpour H. Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial. World J Urol. 2021;39(4):1263 [Crossref]

14- Wang L, Wang Y, Ma L, Wang Y, Mu X, Huang Z, Zheng Z, Nie H. Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial. DDDT. 2023;Volume 17:1233 [Crossref]

15- Esmaillian M, Kouhestani S, Azizkhani R, Heydari F, Safavi M. Dexmedetomidine versus propofol: An effective combination with ketamine for adult procedural sedation: A randomized clinical trial. The American Journal of Emergency Medicine. 2023;73:95 [Crossref]

16- Elsherbiny M, Hasanin A, Kasem S, Abouzeid M, Mostafa M, Fouad A, Abdelwahab Y. Comparison of different ratios of propofol-ketamine admixture in rapid-sequence induction of anesthesia for emergency laparotomy: a randomized controlled trial. BMC Anesthesiol. 2023;23(1) [Crossref]

17- Hinkelbein J, Schmitz J, Lamperti M, Fuchs-Buder T. Procedural sedation outside the operating room. 2020;33(4):533 [Crossref]

18- Kim S, Chang B, Ahn H, Kim J, Yang M, Kim H, Jeong B. Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside. Medicina. 2022;58(12):1762 [Crossref]

19- Zaki H, Shalik N, Shaban E, Bashir K, Iftikhar H, Mohamed Khair Y, Abdelrahim M, Fayed M, Hendy M, Salem E, Elmoheen A. 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. 2022; [Crossref]

20- Aşkın A, Kefeli Çelik H, Doğanay Z. The Effects of Propofol and Ketofol on Hemodynamics, End-Tidal Carbon Dioxide, Integrated Pulmonary Index and Recovery in Patients Undergoing Endoscopy and Colonoscopy. cjms. 2023;8(4):264 [Crossref]

21- Ali I, Alahdal M, Xia H, S. El. Moughrabi A, Shiqian H, Yao S. Ketofol performance to reduce postoperative emergence agitation in children undergoing adenotonsillectomy. Libyan Journal of Medicine. 2020;15(1):1688450 [Crossref]

22- Ghojazadeh M, Paknezhad S, Mohammadzadeh S, Vahed N, Vand Rajabpour Z, Rezaee M, Soleimanpour H. Dexmedetomidine for Procedural Sedation in the Emergency Department: A Systematic Review. Shiraz E-Med J. 2021;23(1) [Crossref]

23- Aljabari S, Ohler A, Waheed S, El-Halabi I, Tryon C, Friedman S. Topical Pharyngeal Anesthesia in Sedated Pediatric Patients Undergoing Esophagogastroduodenoscopy. 2023;76(5):667 [Crossref]

24- Moradkhani M, Shabaninia S, Vahabi S. Comparison between ketamine and propofol combined against propofol alone for brachial plexus nerve block in open fixation of forearm fracture: A randomized controlled trial. 2020;27:136 [Crossref]

25- Morteza Bagi H, Ahmadi S, Tarighat F, Rahbarghazi R, Soleimanpour H. Interplay between exosomes and autophagy machinery in pain management: State of the art. Neurobiology of Pain. 2022;12:100095 [Crossref]

26- Nair A, Dudhedia U, Thakre M, Borkar N. Efficacy of memantine premedication in alleviating postoperative pain- A systematic review and meta-analysis. 2024;18(1):86 [Crossref]

27- Walravens S, Buylaert W, Steen E, De Paepe P. Implementation of a protocol using ketamine-propofol (‘ketofol’) in a 1 to 4 ratio for procedural sedation in adults at a university hospital emergency department – report on safety and effectiveness. Acta Clinica Belgica. 2021;76(5):359 [Crossref]

28- Iqbal A, Shuster M, Baum C. Ketofol for Procedural Sedation and Analgesia in the Pediatric Population. Pediatr Emer Care. 2022;38(1):28 [Crossref]

29- Leshchenko R, Levit A, Davydova N. Procedural sedation and/or analgesia: a review. Annals of Critical Care. 2023;(2):117 [Crossref]

30- Bahreini M, Talebi Garekani M, Sotoodehnia M, Rasooli F. Comparison of the efficacy of ketamine– propofol versus sodium thiopental–fentanyl in sedation: a randomised clinical trial. Emerg Med J. 2021;38(3):211 [Crossref]

31- Tran V, Whitfield J, Askaroff N, Barrington G. Procedural Sedation and Analgesia in an Australian Emergency Department: Results of the First 3 Months of a Procedural Sedation Registry. Anesthesia Research. 2024;1(3):157 [Crossref]

32- Bakan M, Umutoglu T, Topuz U, Guler E, Uysal H, Ozturk E. Prospective evaluation of remifentanil‑propofol mixture for total intravenous anesthesia: A randomized controlled study. Exp Ther Med. 2021;22(5) [Crossref]

33- Grégoire C, De Kock M, Henrie J, Cren R, Lavand'homme P, Penaloza A, Verschuren F. Procedural Sedation With Dexmedetomidine in Combination With Ketamine in the Emergency Department. The Journal of Emergency Medicine. 2022;63(2):283 [Crossref]

34- Yang S, Yi D, Choi G, Lim I, Chae S, Yun S, Lee N, Kim S, Choi E. Effects of Sedation Performed by an Anesthesiologist on Pediatric Endoscopy: a Single-Center Retrospective Study in Korea. J Korean Med Sci. 2020;35(21) [Crossref]

35- Han C, Ji H, Guo Y, Fei Y, Wang C, Yuan Y, Ruan Z, Ma T. Effect of Subanesthetic Dose of Esketamine on Perioperative Neurocognitive Disorders in Elderly Undergoing Gastrointestinal Surgery: A Randomized Controlled Trial. DDDT. 2023;Volume 17:863 [Crossref]

36- YANMAZ L, DOĞAN E, ŞENOCAK M, ERSÖZ U, OKUR S. Beyaz Yeni Zelanda Tavşanlarda Farklı Oranlarda Ketamine ve Propofol (Ketofol) Karışımının Anestezi İndüksiyonu Üzerine Etkilerinin Karşılaştırılması. 2020;:251 [Crossref]

37- Petrucci E, Cofini V, Pizzi B, Cascella M, Marrocco G, Ceccaroni G, Necozione S, Vittori A, Marinangeli F. Pain in critically ill COVID-19 patients: An Italian retrospective study. 2022;17(1):1803 [Crossref]

38- Bhardwaj P, Panneerselvam S, Rudingwa P, Govindaraj K, Prakash M, Badhe A, Nagarajan K. Comparison of airway collapsibility following single induction dose ketamine with propofol versus propofol sedation in children undergoing magnetic resonance imaging: A randomised controlled study. 2024;68(2):189 [Crossref]