title: Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial.
abstract: We determine whether emergency physician-provided deep sedation with 1:1 ketofol versus propofol results in fewer adverse respiratory events requiring physician intervention when used for procedural sedation and analgesia.
  
  
  
  Consenting patients requiring deep sedation were randomized to receive either ketofol or propofol in a double-blind fashion according to a weight-based dosing schedule. The primary outcome was the occurrence of a respiratory adverse event (desaturation, apnea, or hypoventilation) requiring an intervention by the sedating physician. Secondary outcomes included hypotension and patient satisfaction.
  
  
  
  Five hundred seventy-three patients were enrolled and randomized, 292 in the propofol group and 281 in the ketofol group. Five percent in the propofol group and 3% in the ketofol group met the primary outcome, an absolute difference of 2% (95% confidence interval [CI] -2% to 5%). Patients receiving propofol were more likely to become hypotensive (8 versus 1%; difference 7%; 95% CI 4% to 10%). Patient satisfaction was very high in both groups (10/10; interquartile range 10 to 10/10), and although the ketofol group was more likely to experience severe emergence delirium (5% versus 2%; difference 3%; 95% CI 0.4% to 6%), they had lower pain scores at 30 minutes postprocedure. Other secondary outcomes were similar between groups.
  
  
  
  Ketofol and propofol resulted in a similar incidence of adverse respiratory events requiring the intervention of the sedating physician. Although propofol resulted in more hypotension, the clinical relevance of this is questionable, and both agents are associated with high levels of patient satisfaction.
authors.affiliation: Liverpool Hospital, Sydney, NSW, Australia; South West Clinical School, University of NSW, Sydney, Australia. Electronic address: ianferguson@doctors.org.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Ferguson
authors.affiliation: Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.affiliation: Bundaberg Hospital, QLD, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Treston
authors.affiliation: Queensland University of Technology, Brisbane, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: New
authors.affiliation: Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia.
authors.forename: Mingshuang
authors.initials: M
authors.lastname: Ding
authors.affiliation: Liverpool Hospital, Sydney, NSW, Australia; South West Clinical School, University of NSW, Sydney, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D001049:Apnea / Q000139:chemically induced; D054810:Deep Sedation / Q000379:methods*; D004311:Double-Blind Method; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007040:Hypoventilation / Q000139:chemically induced; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D007649:Ketamine; D015742:Propofol