Anesthesia Induction: Propofol, Ketamine or Ketofol: Which one do you use?
Published
Jan 17, 2023
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Jesús Andrés Henao Zapata
https://orcid.org/0000-0002-1079-1155
Catalina Herrera Echeverry
https://orcid.org/0000-0002-3690-0049
Jorge Steven Montealegre Arturo
https://orcid.org/0000-0001-5155-0254
Rafael Antonio Ordoñez Lizarralde
https://orcid.org/0000-0003-0618-1714
Juan Camilo Valbuena Pabón
https://orcid.org/0000-0002-0390-2734
https://orcid.org/0000-0002-1079-1155
Catalina Herrera Echeverry
https://orcid.org/0000-0002-3690-0049
Jorge Steven Montealegre Arturo
https://orcid.org/0000-0001-5155-0254
Rafael Antonio Ordoñez Lizarralde
https://orcid.org/0000-0003-0618-1714
Juan Camilo Valbuena Pabón
https://orcid.org/0000-0002-0390-2734
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Abstract
Introduction: General anesthesia divides in different stages where one of the most critical is the induction of anesthesia and the drugs used in it. Propofol and Ketamine being the most recognized
Objective: Conduct a review of the pharmacokinetic and pharmacodynamic properties of these two drugs, for making decisions about situations in which each of them should be used separately or concomitant
Materials and methods: Four separate searches in the PUBMED database where performed, obtaining a total of 27 bibliographies for the review
Results: Propofol is a hypnotic agent used for short procedures in patients that are hemodynamically stable. Ketamine has a pharmacodynamic properties that are ideal for patients with hemodynamic instability. Ketofol is a drug alternative that achieves synergism, allowing the benefits of each of these drugs to be maintained and reducing the probability of adverse effects
Conclusion: Depending on the procedure to be performed and the hemodynamic stability of each patient one drug may be preferred over another
Key words: Anesthesia, Anesthesia induction, Propofol, Ketamine, Ketofol
Keywords
Anesthesia, Anesthesia induction, Propofol, Ketamine, KetofolAnestesia, Inducción anéstesica, Propofol, Ketamina, Ketofol
References
1. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Christine Stock M, Ortega R. Manual de anestesia clínica. 7.ª ed. Chicago: Wolters Kluwer; 2014.
2. Muñoz Sánchez S. Fisiología y anestesia: aproximación fisiológica a la anestesiología. Cali: Universidad del Valle; 2008.
3. García-Alonso I, Herrero de la Parte B, González Bada A. Conceptos básicos de anestesia [internet]. 2016. Disponible en: https://www.google.com.co/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiavOLQk4H7AhWgTDABHWBVAVUQFnoECBEQAQ&url=http%3A%2F%2Fwww.oc.lm.ehu.eus%2FDepartamento%2FOfertaDocente%2FTeledocencia%2FLeioa%2FOdonto%2FCap%252039%2520Anestesia.pdf&usg=AOvVaw2kuOkqlbJrtBI84CKF4tFm
4. Eichhorn JH. History of anesthesia patient safety. Int Anesthesiol Clin. 2018;56(2):65-93. https://doi.org/10.1097/AIA.0000000000000186
5. Sociedad Argentina de Terapia Intensiva. Vía aérea manejo y control integral. 2.ª ed. Buenos Aires: Editorial Médica Panamericana; 2017.
6. Lupton T, Pratt O. Intravenous drugs used for the induction of anaesthesia [internet]. Disponible en: https://www.studocu.com/latam/u/26942483?sid=01666899869
7. Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015;29(7):543-63. https://doi.org/10.1007/s40263-015-0259-6
8. Sahinovic MM, Struys MMRF, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet. 2018;57(12):1539-58. https://doi.org/10.1007/s40262-018-0672-3
9. Favetta P, Degoute CS, Perdrix JP, Dufresne C, Boulieu R, Guitton J. Propofol metabolites in man following propofol induction and maintenance. Br J Anaesthesia. 2002;88(5):653-8. https://doi.org/10.1093/bja/88.5.653
10. Kobayashi M, Oi Y. Actions of propofol on neurons in the cerebral cortex. J Nippon Med Sch. 2017;84(4):165-9. https://doi.org/10.1272/jnms.84.165
11. Zheng H, Zhu Y, Chen K, Shen X. The effect of etomidate or propofol on brainstem function during anesthesia induction: a bispectral index-guided study. Drug Des Devel Ther. 2019;13:1941-6. https://doi.org/10.2147/DDDT.S211523
12. Burburan SM, Xisto DG, Rocco PRM. Anaesthetic management in asthma. Minerva Anestesiol [internet]. 2007;73(6):357-65. Disponible en: http://lnx.mednemo.it/wp-content/uploads/2008/11/anaesthetic-management-in-asthma.pdf
13. Rüsch D, Arndt C, Eberhart L, Tappert S, Nageldick D, Wulf H. Bispectral index to guide induction of anesthesia: A randomized controlled study. BMC Anesthesiol. 2018;18(1):1-10.
14. Soleimani A, Heidari N, Habibi MR, Kiabi FH, Khademloo M, Emami Zeydi A, et al. Comparing hemodynamic responses to diazepam, propofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery: a double-blind, randomized clinical trial. Med Arch. 2017;71(3):198-203. https://doi.org/10.5455/medarh.2017.71.198-203
15. Aggarwal S, Goyal VK, Chaturvedi SK, Mathur V, Baj B, Kumar A. A comparative study between propofol and etomidate in patients under general anesthesia. Braz J Anesthesiol. 2016;66(3):237-41. https://doi.org/10.1016/j.bjane.2014.10.005
16. Kawasaki S, Kiyohara C, Tokunaga S, Hoka S. Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study. BMC Anesthesiol. 2018;18(1):1-10. https://doi.org/10.1186/s12871-018-0633-2
17. Butterworth IV JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s clinical anesthesiology. 6.ª ed. New York: McGraw-Hill; 2018.
18. Miller R, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N. Miller Anestesia. 8.ª ed. Philadelphia: Elsevier; 2015.
19. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy. Clin Pharmacokinet. 2016;55(9):1059-77.
20. Nowacka A, Borczyk M. Ketamine applications beyond anesthesia: a literature review. Eur J Pharmacol. 2019;860(July):172547. https://doi.org/10.1016/j.ejphar.2019.172547
21. Mion G. History of anaesthesia: the ketamine story - past, present and future. Eur J Anaesthesiol. 2017;34(9):571-5.
22. Braun P, Wenzel V, Paal P. Anesthesia in prehospital emergencies and in the emergency department. Curr Opin Anaesthesiol. 2010;23(4):500-6.
23. Marland S, Ellerton J, Andolfatto G, Strapazzon G, Thomassen O, Brandner B, et al. Ketamine: use in anesthesia. CNS Neurosci Therapeut. 2013;19(6):381-9.
24. Barrett W, Buxhoeveden M, Dhillon S. Ketamine: a versatile tool for anesthesia and analgesia. Curr Opin Anaesthesiol. 2020;33(5):633-8.
25. Nejati A, Moharari RS, Ashraf H, Labaf A, Golshani K. Ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia in the emergency department: a randomized, prospective, double-blind trial. Academic Emerg Med. 2011;18(8):800-6.
26. Yan JW, McLeod SL, Iansavitchene A. ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(9):1003-13.
27. Miner JR, Moore JC, Austad EJ, Plummer D, Hubbard L, Gray RO. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015;65(5). https://doi.org/10.1016/j.annemergmed.2014.08.046
28. Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, et al. Ketamine-propofol combination (Ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012;59(6):504-512.e2. https://doi.org/10.1016/j.annemergmed.2012.01.017
29. de Moraes AG, Racedo Africano CJ, Hoskote SS, Reddy DRS, Tedja R, Thakur L, et al. Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients: a case series. Am J Case Rep. 2015;16:81-6.
30. Smischney NJ, Hoskote SS, Gallo de Moraes A, Racedo Africano CJ, Carrera PM, Tedja R, et al. Ketamine/propofol admixture (ketofol) at induction in the critically ill against etomidate (Keep Pace trial): study protocol for a randomized controlled trial. Trials. 2015;16(1):1-12.
31. Jalili M, Bahreini M, Doosti-Irani A, Masoomi R, Arbab M, Mirfazaelian H. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med. 2016;34(3):558-69. https://doi.org/10.1016/j.ajem.2015.12.074
32. Lemoel F, Contenti J, Giolito D, Boiffier M, Rapp J, Istria J, et al. Adverse events with ketamine versus ketofol for procedural sedation on adults: a double-blind, randomized controlled trial. Acad Emerg Med. 2017;24(12):1441-9.
33. Kumar N, Rajan S, Kumar L. Efficacy of ketofol in blunting hypotensive effects of propofol during induction and its effect on intraoperative anesthetic requirements and recovery profile. Anesth Essays Res. 14(4):605-10. https://doi.org/10.4103/aer.AER_27_21
34. Hayes JA, Aljuhani T, de Oliveira K, Johnston BC. Safety and efficacy of the combination of propofol and ketamine for procedural sedation/anesthesia in the pediatric population: a systematic review and meta-analysis. Anesth Analg. 2021;132(4):979-92. https://doi.org/10.1213/ANE.0000000000004967
35. Ferguson I, Bell A, Treston G, New L, Ding M, Holdgate A. Propofol or ketofol for procedural sedation and analgesia in emergency medicine—The POKER study: a randomized double-blind clinical trial. Ann Emerg Med. 2016 Nov 1;68(5):574-582.e1. https://doi.org/10.1016/j.annemergmed.2016.05.024
36. Mohammad Khalil A, Botros JM, Boules ML, Ragab SG. Reliable and rapid smooth extubation after “ketamine-propfol mixture” for induction of general anesthesia in laparoscopic drilling of polycystic ovary: a randomized, double-blind, comparative study. Anesth Pain Med. 2021 Apr 1;11(2).
37. Aberra B, Aregawi A, Teklay G, Tasew H. Effect of ketofol versus propofol as an induction agent on ease of laryngeal mask airway insertion conditions and hemodynamic stability in pediatrics: an observational prospective cohort study. BMC Anesthesiol. 2019 Mar 20;19(1).
38. Biliškov AN, Ivančev B, Pogorelić Z. Effects on recovery of pediatric patients undergoing total intravenous anesthesia with Propofol versus Ketofol for short-lasting laparoscopic procedures. Children. 2021 Jul 1;8(7).
39. Yousef G, Elsayed K. A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children. Anesth Essays Res. 2013;7(2):194. https://doi.org/10.4103/0259-1162.118957
40. Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011 May;57(5):425-33. https://doi.org/10.1016/j.annemergmed.2010.08.032
41. Green SM, Andolfatto G, Krauss B. Ketofol for procedural sedation? Pro and con. Ann Emerg Med. 2011;57(5):444-8. https://doi.org/10.1016/j.annemergmed.2010.12.009
2. Muñoz Sánchez S. Fisiología y anestesia: aproximación fisiológica a la anestesiología. Cali: Universidad del Valle; 2008.
3. García-Alonso I, Herrero de la Parte B, González Bada A. Conceptos básicos de anestesia [internet]. 2016. Disponible en: https://www.google.com.co/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiavOLQk4H7AhWgTDABHWBVAVUQFnoECBEQAQ&url=http%3A%2F%2Fwww.oc.lm.ehu.eus%2FDepartamento%2FOfertaDocente%2FTeledocencia%2FLeioa%2FOdonto%2FCap%252039%2520Anestesia.pdf&usg=AOvVaw2kuOkqlbJrtBI84CKF4tFm
4. Eichhorn JH. History of anesthesia patient safety. Int Anesthesiol Clin. 2018;56(2):65-93. https://doi.org/10.1097/AIA.0000000000000186
5. Sociedad Argentina de Terapia Intensiva. Vía aérea manejo y control integral. 2.ª ed. Buenos Aires: Editorial Médica Panamericana; 2017.
6. Lupton T, Pratt O. Intravenous drugs used for the induction of anaesthesia [internet]. Disponible en: https://www.studocu.com/latam/u/26942483?sid=01666899869
7. Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015;29(7):543-63. https://doi.org/10.1007/s40263-015-0259-6
8. Sahinovic MM, Struys MMRF, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet. 2018;57(12):1539-58. https://doi.org/10.1007/s40262-018-0672-3
9. Favetta P, Degoute CS, Perdrix JP, Dufresne C, Boulieu R, Guitton J. Propofol metabolites in man following propofol induction and maintenance. Br J Anaesthesia. 2002;88(5):653-8. https://doi.org/10.1093/bja/88.5.653
10. Kobayashi M, Oi Y. Actions of propofol on neurons in the cerebral cortex. J Nippon Med Sch. 2017;84(4):165-9. https://doi.org/10.1272/jnms.84.165
11. Zheng H, Zhu Y, Chen K, Shen X. The effect of etomidate or propofol on brainstem function during anesthesia induction: a bispectral index-guided study. Drug Des Devel Ther. 2019;13:1941-6. https://doi.org/10.2147/DDDT.S211523
12. Burburan SM, Xisto DG, Rocco PRM. Anaesthetic management in asthma. Minerva Anestesiol [internet]. 2007;73(6):357-65. Disponible en: http://lnx.mednemo.it/wp-content/uploads/2008/11/anaesthetic-management-in-asthma.pdf
13. Rüsch D, Arndt C, Eberhart L, Tappert S, Nageldick D, Wulf H. Bispectral index to guide induction of anesthesia: A randomized controlled study. BMC Anesthesiol. 2018;18(1):1-10.
14. Soleimani A, Heidari N, Habibi MR, Kiabi FH, Khademloo M, Emami Zeydi A, et al. Comparing hemodynamic responses to diazepam, propofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery: a double-blind, randomized clinical trial. Med Arch. 2017;71(3):198-203. https://doi.org/10.5455/medarh.2017.71.198-203
15. Aggarwal S, Goyal VK, Chaturvedi SK, Mathur V, Baj B, Kumar A. A comparative study between propofol and etomidate in patients under general anesthesia. Braz J Anesthesiol. 2016;66(3):237-41. https://doi.org/10.1016/j.bjane.2014.10.005
16. Kawasaki S, Kiyohara C, Tokunaga S, Hoka S. Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study. BMC Anesthesiol. 2018;18(1):1-10. https://doi.org/10.1186/s12871-018-0633-2
17. Butterworth IV JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s clinical anesthesiology. 6.ª ed. New York: McGraw-Hill; 2018.
18. Miller R, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N. Miller Anestesia. 8.ª ed. Philadelphia: Elsevier; 2015.
19. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy. Clin Pharmacokinet. 2016;55(9):1059-77.
20. Nowacka A, Borczyk M. Ketamine applications beyond anesthesia: a literature review. Eur J Pharmacol. 2019;860(July):172547. https://doi.org/10.1016/j.ejphar.2019.172547
21. Mion G. History of anaesthesia: the ketamine story - past, present and future. Eur J Anaesthesiol. 2017;34(9):571-5.
22. Braun P, Wenzel V, Paal P. Anesthesia in prehospital emergencies and in the emergency department. Curr Opin Anaesthesiol. 2010;23(4):500-6.
23. Marland S, Ellerton J, Andolfatto G, Strapazzon G, Thomassen O, Brandner B, et al. Ketamine: use in anesthesia. CNS Neurosci Therapeut. 2013;19(6):381-9.
24. Barrett W, Buxhoeveden M, Dhillon S. Ketamine: a versatile tool for anesthesia and analgesia. Curr Opin Anaesthesiol. 2020;33(5):633-8.
25. Nejati A, Moharari RS, Ashraf H, Labaf A, Golshani K. Ketamine/propofol versus midazolam/fentanyl for procedural sedation and analgesia in the emergency department: a randomized, prospective, double-blind trial. Academic Emerg Med. 2011;18(8):800-6.
26. Yan JW, McLeod SL, Iansavitchene A. ketamine-propofol versus propofol alone for procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(9):1003-13.
27. Miner JR, Moore JC, Austad EJ, Plummer D, Hubbard L, Gray RO. Randomized, double-blinded, clinical trial of propofol, 1:1 propofol/ketamine, and 4:1 propofol/ketamine for deep procedural sedation in the emergency department. Ann Emerg Med. 2015;65(5). https://doi.org/10.1016/j.annemergmed.2014.08.046
28. Andolfatto G, Abu-Laban RB, Zed PJ, Staniforth SM, Stackhouse S, Moadebi S, et al. Ketamine-propofol combination (Ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Ann Emerg Med. 2012;59(6):504-512.e2. https://doi.org/10.1016/j.annemergmed.2012.01.017
29. de Moraes AG, Racedo Africano CJ, Hoskote SS, Reddy DRS, Tedja R, Thakur L, et al. Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients: a case series. Am J Case Rep. 2015;16:81-6.
30. Smischney NJ, Hoskote SS, Gallo de Moraes A, Racedo Africano CJ, Carrera PM, Tedja R, et al. Ketamine/propofol admixture (ketofol) at induction in the critically ill against etomidate (Keep Pace trial): study protocol for a randomized controlled trial. Trials. 2015;16(1):1-12.
31. Jalili M, Bahreini M, Doosti-Irani A, Masoomi R, Arbab M, Mirfazaelian H. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med. 2016;34(3):558-69. https://doi.org/10.1016/j.ajem.2015.12.074
32. Lemoel F, Contenti J, Giolito D, Boiffier M, Rapp J, Istria J, et al. Adverse events with ketamine versus ketofol for procedural sedation on adults: a double-blind, randomized controlled trial. Acad Emerg Med. 2017;24(12):1441-9.
33. Kumar N, Rajan S, Kumar L. Efficacy of ketofol in blunting hypotensive effects of propofol during induction and its effect on intraoperative anesthetic requirements and recovery profile. Anesth Essays Res. 14(4):605-10. https://doi.org/10.4103/aer.AER_27_21
34. Hayes JA, Aljuhani T, de Oliveira K, Johnston BC. Safety and efficacy of the combination of propofol and ketamine for procedural sedation/anesthesia in the pediatric population: a systematic review and meta-analysis. Anesth Analg. 2021;132(4):979-92. https://doi.org/10.1213/ANE.0000000000004967
35. Ferguson I, Bell A, Treston G, New L, Ding M, Holdgate A. Propofol or ketofol for procedural sedation and analgesia in emergency medicine—The POKER study: a randomized double-blind clinical trial. Ann Emerg Med. 2016 Nov 1;68(5):574-582.e1. https://doi.org/10.1016/j.annemergmed.2016.05.024
36. Mohammad Khalil A, Botros JM, Boules ML, Ragab SG. Reliable and rapid smooth extubation after “ketamine-propfol mixture” for induction of general anesthesia in laparoscopic drilling of polycystic ovary: a randomized, double-blind, comparative study. Anesth Pain Med. 2021 Apr 1;11(2).
37. Aberra B, Aregawi A, Teklay G, Tasew H. Effect of ketofol versus propofol as an induction agent on ease of laryngeal mask airway insertion conditions and hemodynamic stability in pediatrics: an observational prospective cohort study. BMC Anesthesiol. 2019 Mar 20;19(1).
38. Biliškov AN, Ivančev B, Pogorelić Z. Effects on recovery of pediatric patients undergoing total intravenous anesthesia with Propofol versus Ketofol for short-lasting laparoscopic procedures. Children. 2021 Jul 1;8(7).
39. Yousef G, Elsayed K. A clinical comparison of ketofol (ketamine and propofol admixture) versus propofol as an induction agent on quality of laryngeal mask airway insertion and hemodynamic stability in children. Anesth Essays Res. 2013;7(2):194. https://doi.org/10.4103/0259-1162.118957
40. Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011 May;57(5):425-33. https://doi.org/10.1016/j.annemergmed.2010.08.032
41. Green SM, Andolfatto G, Krauss B. Ketofol for procedural sedation? Pro and con. Ann Emerg Med. 2011;57(5):444-8. https://doi.org/10.1016/j.annemergmed.2010.12.009
How to Cite
Henao Zapata, J. A., Herrera Echeverry, C., Montealegre Arturo, J. S., Ordoñez Lizarralde, R. A., & Valbuena Pabón, J. C. (2023). Anesthesia Induction: Propofol, Ketamine or Ketofol: Which one do you use? . Universitas Medica, 63(4). https://doi.org/10.11144/Javeriana.umed63-4.prop
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