Objective
Sedation is an effective component of care in ICU patients. The aim of this study was to evaluate the safety and efficacy of ketamine/propofol combination in short term sedation for the critically ill patients in ICU.
Design
Prospective case series study.
Setting
Intensive care unit (ICU) in a tertiary hospital (Kasr Al Aini).
Methods
Fourteen critically ill patients who were mechanically ventilated and were in need for sedation were included in this case series. An initial bolus dose (500 μg/kg) of ketamine/propofol 1:1 (ketamine 8 mg/ml and propofol 8 mg/ml) was given to all patients followed by a maintenance dose of 10 μg/kg/min and the infusion dose adjusted (in 5 μg/kg/min increments) to achieve Ramsay Sedation Scale of 4. Recorded parameters included heart rate, systolic blood pressure, Ramsay score, the need for use of noradrenalin and the recovery time from discontinuation of sedation.
Results
The mean and standard deviation of the age of the patients was 60 ± 14.5 y and their APACHEII score ranged from 18 to 35. The median initial bolus dose of ketofol administered was 5 ml of aliquot with median infusion rate 6 ml/h (range: 4.8–7.5 ml/h) only three patients (21.4%) needed the infusion rate to be increased to achieve Ramsay score 4. Only one patient experienced hypotension due to hypovolemia secondary to internal hemorrhage.
Conclusion
Continuous intravenous infusion of ketofol may provide adequate and safe short term sedation (less than 24 h) for critically ill patients in the intensive care units, with rapid recovery and no clinically significant complications. Further studies with larger number of patients are required to evaluate and validate these findings.