title: Ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia in the emergency department: a randomized, prospective, double-blind trial.
abstract: OBJECTIVE
  The authors performed a prospective, double-blinded, randomized trial with emergency department (ED) patients requiring procedural sedation and analgesia (PSA) for repair of deep traumatic lacerations and reduction of bone fractures, to compare the ketamine/propofol (ketofol) combination with the midazolam/fentanyl (MF) combination.
  
  
  METHODS
  Sixty-two patients scheduled for PSA who presented between January 2009 and June 2009 were enrolled prospectively. Thirty-one were randomly assigned to the ketofol group, and 31 were assigned to the MF group.
  
  
  RESULTS
  The median starting doses were 0.75 mg/kg of both ketamine and propofol (interquartile range [IQR] = 0.75 to 1.5 mg/kg), 0.04 mg/kg midazolam (IQR = 0.04 to 0.06 mg/kg), and 2 μg/kg fentanyl (IQR = 2 to 3 μg/kg). There were no significant differences in sedation time between the groups. There were no differences in physician satisfaction (p = 0.065). Perceived pain in the ketofol group, as measured by the Visual Analog Scale (VAS), was significantly lower than in the MF group (median ketofol = 0, IQR = 0-1 vs. median MF = 3, IQR = 1-6; p < 0.001). Only one patient in each group required bag-mask ventilation, and neither of them were intubated.
  
  
  CONCLUSIONS
  The ketamine/propofol combination provides adequate sedation and analgesia for painful procedures and appears to be a safe and useful technique in the ED.
authors.affiliation: Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Nejati
authors.forename: Reza Shariat
authors.initials: RS
authors.lastname: Moharari
authors.forename: Haleh
authors.initials: H
authors.lastname: Ashraf
authors.forename: Ali
authors.initials: A
authors.lastname: Labaf
authors.forename: Keihan
authors.initials: K
authors.lastname: Golshani
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D004311:Double-Blind Method; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D022125:Lacerations / Q000628:therapy; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000759:Adjuvants, Anesthesia; D000700:Analgesics; D018686:Anesthetics, Intravenous; D004338:Drug Combinations; D007649:Ketamine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol