• Andrew Greer and Greg Treston.
• Paediatric Intensive Care, Starship Children's Health, Auckland, New Zealand.
• Emerg Med Australas. 2018 Apr 1; 30 (2): 200-208.

ObjectivesTo describe the proportion of patients reporting procedural memory following procedural sedation and analgesia (PSA) with ketamine and propofol (KP) administered premixed together (ketofol) or individually (sequential KP) in ED attendees. Identify any clinical or demographic variables associated with procedural memory.MethodsThis was a convenience sample of 563 patients who received KP PSA as per the departmental protocol. A standardised script was used to assess for procedural memory. This was categorised as 'any' and 'unpleasant' prior to discharge (immediate memory) and at telephone follow up (delayed memory).ResultsA total of 318 patients had sequential KP and 249 premixed 1:1 ketofol. For sequential KP compared to ketofol, the proportion reporting any memory was as follows: 3.5% versus 3.3% immediate, 4.4% versus 5.5% delayed and 5.4% versus 7.4% for the sum of these. For unpleasant memory, the proportion was as follows: 1.6% versus 2.9% immediate, 1.7% versus 4.7% delayed and 2.2% versus 6.9% all unpleasant memory (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.4-8.1). Memory was associated with male sex (OR 4, 95% CI 1.5-10.5), opiates (OR 3, 95% CI 1.7-7.5), a Wisconsin Sedation Scale score ≥3 (moderate sedation) (OR 4.3, 95% CI 1.1-18.2) and propofol dose <0.75 mg/kg compared to >0.75 mg/kg (13% versus 3%) (OR 6, 95% CI 1.7-21). The ketofol group had 5% (95% CI 0.1-10) more respiratory events requiring intervention.ConclusionsProcedural memory was uncommon for both mix types; however, a greater proportion of the premixed ketofol group had unpleasant memory. Associations with sex, opiates, moderate sedation and propofol dose were identified, and respiratory adverse events were more common in the premixed ketofol group.© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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