title: Ketamine and propofol combination ("ketofol") for endotracheal intubations in critically ill patients: a case series.
abstract: BACKGROUND
  Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles. No data are available about the use of this combination in critically ill patients undergoing endotracheal intubation.
  
  
  METHODS
  We describe 6 cases in which the combination of ketamine and propofol ("ketofol") was used as an induction agent for endotracheal intubation in critically ill patients with a focus on hemodynamic outcomes. All patients received a neuromuscular blocker and fentanyl, while 5 patients received midazolam. We recorded mean arterial pressure (MAP) 1 minute before induction and 15 minutes after intubation with the combination. Of the 6 patients, 5 maintained a MAP ≥ 65 mmHg 15 minutes after intubation. One patient was on norepinephrine infusion with a MAP of 64 mmHg, and did not require an increase in the dose of the vasopressor 15 minutes after intubation. No hemodynamic complications were reported after any of the intubations.
  
  
  CONCLUSIONS
  This case series describes the use of the "ketofol" combination as an induction agent for intubation in critically ill patients when hemodynamic stability is desired. Further research is needed to establish the safety of this combination and how it compares to other induction medications.
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Alice
authors: A
authors: Gallo de Moraes
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Carlos J
authors: CJ
authors: Racedo Africano
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Sumedh S
authors: SS
authors: Hoskote
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Dereddi Raja S
authors: DR
authors: Reddy
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Rudy
authors: R
authors: Tedja
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Lokendra
authors: L
authors: Thakur
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Jasleen K
authors: JK
authors: Pannu
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Elizabeth C
authors: EC
authors: Hassebroek
authors: Department of Anesthesiology, Division of Critical Care Medicine and Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA.
authors: Nathan J
authors: NJ
authors: Smischney
mesh_terms: D000328:Adult; D000368:Aged; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016638:Critical Illness / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage*
chemical_list: D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D015742:Propofol