Ketamine and Propofol Are Equally Effective for Procedural Sedation in Adults-propofol 只要5-6cc 即可!
Ketamine and Propofol Are Equally Effective for Procedural Sedation in Adults
But propofol is associated with more-rapid recovery and less respiratory depression.
Studies show that propofol is safe and effective for procedural sedation in adults (JW Emerg Med Jan 4 2008, JW Emerg Med Oct 6 2006, JW Emerg Med Feb 14 2006), but research on ketamine has been done primarily in children. In a prospective, randomized, nonblinded trial, researchers compared ketamine and propofol (each administered intravenously at 1 mg/kg followed by 0.5 mg/kg IV every 3 minutes as needed) for sedation in 97 adults undergoing painful procedures in an urban emergency department. Patients with pain were treated with morphine at least 20 minutes before the procedure.
The rate of subclinical respiratory depression (defined as change in end-tidal CO2 [ETCO2]>10 mm Hg, oxygen saturation <92%, or absent ETCO2 waveform) — one part of the primary outcome — was significantly higher in the ketamine group than in the propofol group (63% vs. 40%). Use of airway interventions (repositioning, stimulation, adjuncts, and increased supplemental oxygen) — the second part of the primary outcome — was similar in the two groups; no patient required intubation. Median time to return to baseline mental status was significantly longer in the ketamine group than in the propofol group (14 vs. 5 minutes) and incidence of recovery agitation was significantly higher in the ketamine group (36% vs. 8%, respectively). Median time to procedure completion, rate of successful completion, proportion of patients with procedural recall, and proportion of patients with pain during the procedure were similar in the two groups.
Comment: In adults, propofol still reigns supreme as a procedural sedative. Ketamine seems to be an effective and safe alternative, but this study suggests that it causes more agitation and respiratory depression than propofol. Capnography is required for deep sedation with either agent, and ventilation support might be required for a brief period.
— Diane M. Birnbaumer, MD, FACEP
Published in Journal Watch Emergency Medicine June 18, 2010
Citation(s):
Miner JR et al. Randomized clinical trial of propofol versus ketamine for procedural sedation in the emergency department. Acad Emerg Med 2010 Jun; 17:604.
But propofol is associated with more-rapid recovery and less respiratory depression.
Studies show that propofol is safe and effective for procedural sedation in adults (JW Emerg Med Jan 4 2008, JW Emerg Med Oct 6 2006, JW Emerg Med Feb 14 2006), but research on ketamine has been done primarily in children. In a prospective, randomized, nonblinded trial, researchers compared ketamine and propofol (each administered intravenously at 1 mg/kg followed by 0.5 mg/kg IV every 3 minutes as needed) for sedation in 97 adults undergoing painful procedures in an urban emergency department. Patients with pain were treated with morphine at least 20 minutes before the procedure.
The rate of subclinical respiratory depression (defined as change in end-tidal CO2 [ETCO2]>10 mm Hg, oxygen saturation <92%, or absent ETCO2 waveform) — one part of the primary outcome — was significantly higher in the ketamine group than in the propofol group (63% vs. 40%). Use of airway interventions (repositioning, stimulation, adjuncts, and increased supplemental oxygen) — the second part of the primary outcome — was similar in the two groups; no patient required intubation. Median time to return to baseline mental status was significantly longer in the ketamine group than in the propofol group (14 vs. 5 minutes) and incidence of recovery agitation was significantly higher in the ketamine group (36% vs. 8%, respectively). Median time to procedure completion, rate of successful completion, proportion of patients with procedural recall, and proportion of patients with pain during the procedure were similar in the two groups.
Comment: In adults, propofol still reigns supreme as a procedural sedative. Ketamine seems to be an effective and safe alternative, but this study suggests that it causes more agitation and respiratory depression than propofol. Capnography is required for deep sedation with either agent, and ventilation support might be required for a brief period.
— Diane M. Birnbaumer, MD, FACEP
Published in Journal Watch Emergency Medicine June 18, 2010
Citation(s):
Miner JR et al. Randomized clinical trial of propofol versus ketamine for procedural sedation in the emergency department. Acad Emerg Med 2010 Jun; 17:604.
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