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Combining ketamine with dexmedetomidine (ketodex) or propofol (ketofol) for procedural sedation and analgesia in the emergency department resulted in efficacy, safety, and favorable recovery profiles compared to ketamine alone, with ketodex showing less reduction in oxygen saturation and ketofol exhibiting faster recovery times.

The following is a summary of “Dexmedetomidine versus propofol: An effective combination with ketamine for adult procedural sedation: A randomized clinical trial,” published in the November 2023 issue of Emergency Medicine by Esmaillian, et al.

In recent developments, combinations of drugs have become the preferred choice over single-drug methods for procedural sedation and analgesia (PSA). For a study, researchers sought to discern the efficacy and hemodynamic responses of ketamine-dexmedetomidine (ketodex) and ketofol when juxtaposed against ketamine alone for PSA within the emergency department (ED) setting.

The study followed a prospective, randomized, double-blind clinical trial approach involving adult patients (aged ≥18 years) necessitating PSA for a painful procedure in the ED. A total of 135 patients were evenly distributed into three groups: ketodex, ketofol, or ketamine. If sedation was inadequate, additional ketamine was administered across all groups. Parameters such as oxygen saturation, heart rate, and blood pressure were continuously monitored from baseline to 120 minutes post-PSA induction. Variables like adverse events, hemodynamic parameters, and induction and recovery times were meticulously recorded and compared across the groups.

The average age of the participants was 38.16 ± 19.09 years. No significant differences emerged among the three groups concerning demographic variables, pain scores, or types of procedures. Respiratory events occurred with comparable frequencies across the groups. Interestingly, the Ketodex group experienced a lesser reduction in oxygen saturation (1.9%) compared to the Ketofol (6.5%) and Ketamine (3.8%) groups, a statistically significant difference (P = 0.015). Notably, no patients necessitated endotracheal intubation. Changes in mean arterial pressure from baseline were more pronounced in the Ketamine and Ketofol groups relative to the Ketodex group, with differences of 12.9 mmHg (95% CI, 9.5 to 20.3) and 8.6 mmHg (95% CI, 3.4 to 13.7), respectively. Tachycardia was significantly more prevalent in the Ketamine group. Recovery times were notably faster in the Ketofol group, showing a 9.8-minute difference (95% CI, [2.5 to 17.1]) compared to Ketamine and an 8.3-minute difference (95% CI, [1.5 to 15.1]) relative to Ketodex.

Both ketodex and ketofol combinations demonstrated efficacy and safety, presenting favorable recovery profiles and hemodynamic stability for adult PSA within the ED setting.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004424