Ketofol is a mixture of ketamine and propofol used for sedation during painful procedures. It is easily titrated, rapid in onset, brief in duration and low risk when used properly.
The most commonly used mixture is one mg ketamine to one mg propofol (1:1) but other ratios are used.
A common dose is 0.75 mg per kg body weight of ketamine mixed with 0.75 per kg body weight of propofol. The dose should be titrated to the patient, since some patients may require a smaller or higher dose.
For longer procedures an infusion may be started that contain both drugs. An initial bolus dose is often given, followed by a maintenance infusion. When an infusion is used there may be confusion between doses expressed in mL per kg per hour and mg per kg per hour.
Recommendations:
(1) The ratio of ketamine to propofol should be standardized within an institution to reduce confusion.
(2) Any admixture has an associated risk of bacterial contamination.
(3) A mixture of 1:1 or 3:7 is reported to be stable for up to 3 hours, but the stability of other mixtures may not be established.
(4) Adverse drug effects may be a problem when higher doses are used.
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