title: Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis.
abstract: OBJECTIVE
  This meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA).
  
  
  METHODS
  Medline, EMBASE, Scopus, CINHAL, and Cochrane Central Register of Controlled Trials were searched for clinical trial. The administration complications were the key outcomes of interest.
  
  
  RESULTS
  Eighteen clinical trials that met our criteria were included in the analysis. Pooling of data showed that ketofol is significantly effective for reduction of respiratory complication and with relative risk (RR) of 0.31 in 14 trials (95% confidence interval [CI], 0.47-0.7; P = .001). Ketofol was also effective in reducing cardiovascular complications with hypotension RR of 0.11 in 9 trials (95% CI, 0.17-0.97; P = .04) and bradycardia RR of 0.47 in 8 trials (95% CI, 0.28-0.72; P = .008). The present study also showed that the summary of RR for psychomimetic complications was 1.95 in 13 trials were (95% CI, 0.79-4.81; P = .15) and for muscle rigidity was 0.52 for 2 trials (95% CI, 0.06-4.67; P = .56), and both were insignificant. In regard to nausea and vomiting, the RR was 1.23 in 12 trials (95% CI, 0.39-3.88; P = .72) and insignificant.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates good safety profile in cardiorespiratory problems and comparable rate of other complications with propofol in adult procedural sedation and analgesia.
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jalili
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Bahreini
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amin
authors.initials: A
authors.lastname: Doosti-Irani
authors.affiliation: Department of Medical Educations, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Masoomi
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mona
authors.initials: M
authors.lastname: Arbab
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: H-Mirfazaelian@sina.tums.ac.ir.
authors.forename: Hadi
authors.initials: H
authors.lastname: Mirfazaelian
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods*; D004359:Drug Therapy, Combination; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics; D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D015742:Propofol