title: Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department.
abstract: OBJECTIVE
  We compare the frequency of airway and respiratory adverse events leading to an intervention between propofol with 1:1 and 4:1 mixtures of propofol and ketamine (ketofol).
  
  
  METHODS
  We performed a randomized, double-blinded trial in which emergency department adults undergoing deep sedation received propofol, 1:1 propofol and ketamine, or 4:1 propofol and ketamine. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, procedure and recovery time, patient satisfaction, pain, and procedural recall.
  
  
  RESULTS
  Two hundred seventy-one subjects completed the trial, 90 receiving propofol, 85 receiving 1:1 propofol and ketamine, and 96 receiving 4:1 propofol and ketamine. Airway or respiratory adverse events leading to an intervention were similar between groups: 29%, 19%, and 32%, respectively (P=.21). There were no serious adverse events in any group. Secondary outcomes were generally similar between groups, with greater recovery agitation observed in the 1:1 ketofol group (8%, 21%, and 10%, respectively).
  
  
  CONCLUSIONS
  We found a similar frequency of airway and respiratory adverse events leading to intervention between propofol alone and either 1:1 or 4:1 ketofol.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: jimminer@hotmail.com.
authors.forename: James R
authors.initials: JR
authors.lastname: Miner
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Moore
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Austad
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: David
authors.initials: D
authors.lastname: Plummer
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Laura
authors.initials: L
authors.lastname: Hubbard
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012120:Respiration Disorders / Q000139:chemically induced* / Q000628:therapy; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D015742:Propofol