• James R Miner, Johanna C Moore, Erin J Austad, David Plummer, Laura Hubbard, and Richard O Gray.
• Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: jimminer@hotmail.com.
• Ann Emerg Med. 2015 May 1; 65 (5): 479-488.e2.

Study ObjectiveWe compare the frequency of airway and respiratory adverse events leading to an intervention between propofol with 1:1 and 4:1 mixtures of propofol and ketamine (ketofol).MethodsWe performed a randomized, double-blinded trial in which emergency department adults undergoing deep sedation received propofol, 1:1 propofol and ketamine, or 4:1 propofol and ketamine. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, procedure and recovery time, patient satisfaction, pain, and procedural recall.ResultsTwo hundred seventy-one subjects completed the trial, 90 receiving propofol, 85 receiving 1:1 propofol and ketamine, and 96 receiving 4:1 propofol and ketamine. Airway or respiratory adverse events leading to an intervention were similar between groups: 29%, 19%, and 32%, respectively (P=.21). There were no serious adverse events in any group. Secondary outcomes were generally similar between groups, with greater recovery agitation observed in the 1:1 ketofol group (8%, 21%, and 10%, respectively).ConclusionWe found a similar frequency of airway and respiratory adverse events leading to intervention between propofol alone and either 1:1 or 4:1 ketofol.Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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