title: Sedation with the Combination of Ketamine and Propofol in a Pediatric ED: A Retrospective Case Series Analysis.
abstract: BACKGROUND
  Literature to date has suggested advantages of sedation with the combination of ketamine and propofol over ketamine alone or propofol alone. However, there is a paucity of data regarding sedation with the combination of ketamine and propofol in pediatric emergency medicine.
  
  
  METHODS
  A retrospective case series analysis of children who underwent sedation with the combination of ketamine and propofol in a pediatric emergency department was conducted. Study covariates were extracted from the emergency department medical records.
  
  
  RESULTS
  Four hundred twenty-nine patients, 297 males and 132 females, with a median age of 6.8 years (interquartile range, 3.9-10.9 years), underwent sedation by pediatric emergency physicians. Serious adverse events during sedation (SAEDS) were recorded in 52 procedures (12.1%), which included 39 hypoxic events (9.1%), 12 apneic events (2.8%), and 1 laryngospasm (0.2%). All SAEDS were managed successfully, and no child underwent intubation because of an adverse reaction or required hospitalization. Multivariate logistic regression analysis did not reveal any association between age, weight, fasting time, analgesic medication provided before sedation, length of procedure, capnography use, dosages of medications, and the presence of SAEDS.
  
  
  CONCLUSIONS
  This is the largest reported series of sedation with the combination of ketamine and propofol in pediatric emergency medicine. Findings suggest that sedation with the combination of ketamine and propofol can be safely performed by a skilled emergency physician.
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Eric
authors.initials: E
authors.lastname: Scheier
authors.affiliation: Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Chen
authors.initials: C
authors.lastname: Gadot
authors.affiliation: Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Leiba
authors.affiliation: Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel. Electronic address: i_shavit@rambam.health.gov.il.
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D015742:Propofol / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D015742:Propofol