Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients: A case series

Alice Gallo de Moraes, Carlos J. Racedo Africano, Sumedh S. Hoskote, Dereddi Raja S. Reddy, Rudy Tedja, Lokendra Thakur, Jasleen K. Pannu, Elizabeth C. Hassebroek, Nathan Smischney

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Educational Purpose (only if useful for a systematic review or synthesis)

Case Series: We describe 6 cases in which the combination of ketamine and propofol (“ketofol”) was used as an induction agent for endotracheal intubation in critically ill patients with a focus on hemodynamic outcomes. All patients received a neuromuscular blocker and fentanyl, while 5 patients received midazolam. We recorded mean arterial pressure (MAP) 1 minute before induction and 15 minutes after intubation with the combination. Of the 6 patients, 5 maintained a MAP ³65 mmHg 15 minutes after intubation. One patient was on norepinephrine infusion with a MAP of 64 mmHg, and did not require an increase in the dose of the vasopressor 15 minutes after intubation. No hemodynamic complications were reported after any of the intubations.

Conclusions: This case series describes the use of the “ketofol” combination as an induction agent for intubation in critically ill patients when hemodynamic stability is desired. Further research is needed to establish the safety of this combination and how it compares to other induction medications.

Background: Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles. No data are available about the use of this combination in critically ill patients undergoing endotracheal intubation.

Original languageEnglish (US)
Pages (from-to)81-86
Number of pages6
JournalAmerican Journal of Case Reports
Volume16
DOIs
StatePublished - Feb 13 2015

Fingerprint

Intratracheal Intubation
Ketamine
Propofol
Critical Illness
Intubation
Hemodynamics
Arterial Pressure
Etomidate
Neuromuscular Blocking Agents
Midazolam
Fentanyl
Hypotension
Anesthetics
Norepinephrine
Morbidity
Safety

Keywords

  • Anesthetics
  • Combined
  • Critical illness
  • Drug Combinations
  • Intratracheal ketamine
  • Intubation
  • Propofol

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients : A case series. / de Moraes, Alice Gallo; Racedo Africano, Carlos J.; Hoskote, Sumedh S.; Reddy, Dereddi Raja S.; Tedja, Rudy; Thakur, Lokendra; Pannu, Jasleen K.; Hassebroek, Elizabeth C.; Smischney, Nathan.

In: American Journal of Case Reports, Vol. 16, 13.02.2015, p. 81-86.

Research output: Contribution to journalArticle

de Moraes, AG, Racedo Africano, CJ, Hoskote, SS, Reddy, DRS, Tedja, R, Thakur, L, Pannu, JK, Hassebroek, EC & Smischney, N 2015, 'Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients: A case series', American Journal of Case Reports, vol. 16, pp. 81-86. https://doi.org/10.12659/AJCR.892424
de Moraes, Alice Gallo ; Racedo Africano, Carlos J. ; Hoskote, Sumedh S. ; Reddy, Dereddi Raja S. ; Tedja, Rudy ; Thakur, Lokendra ; Pannu, Jasleen K. ; Hassebroek, Elizabeth C. ; Smischney, Nathan. / Ketamine and propofol combination (“Ketofol”) for endotracheal intubations in critically ill patients : A case series. In: American Journal of Case Reports. 2015 ; Vol. 16. pp. 81-86.
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AU - de Moraes, Alice Gallo

AU - Racedo Africano, Carlos J.

AU - Hoskote, Sumedh S.

AU - Reddy, Dereddi Raja S.

AU - Tedja, Rudy

AU - Thakur, Lokendra

AU - Pannu, Jasleen K.

AU - Hassebroek, Elizabeth C.

AU - Smischney, Nathan

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N2 - Objective: Educational Purpose (only if useful for a systematic review or synthesis)Case Series: We describe 6 cases in which the combination of ketamine and propofol (“ketofol”) was used as an induction agent for endotracheal intubation in critically ill patients with a focus on hemodynamic outcomes. All patients received a neuromuscular blocker and fentanyl, while 5 patients received midazolam. We recorded mean arterial pressure (MAP) 1 minute before induction and 15 minutes after intubation with the combination. Of the 6 patients, 5 maintained a MAP ³65 mmHg 15 minutes after intubation. One patient was on norepinephrine infusion with a MAP of 64 mmHg, and did not require an increase in the dose of the vasopressor 15 minutes after intubation. No hemodynamic complications were reported after any of the intubations.Conclusions: This case series describes the use of the “ketofol” combination as an induction agent for intubation in critically ill patients when hemodynamic stability is desired. Further research is needed to establish the safety of this combination and how it compares to other induction medications.Background: Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles. No data are available about the use of this combination in critically ill patients undergoing endotracheal intubation.

AB - Objective: Educational Purpose (only if useful for a systematic review or synthesis)Case Series: We describe 6 cases in which the combination of ketamine and propofol (“ketofol”) was used as an induction agent for endotracheal intubation in critically ill patients with a focus on hemodynamic outcomes. All patients received a neuromuscular blocker and fentanyl, while 5 patients received midazolam. We recorded mean arterial pressure (MAP) 1 minute before induction and 15 minutes after intubation with the combination. Of the 6 patients, 5 maintained a MAP ³65 mmHg 15 minutes after intubation. One patient was on norepinephrine infusion with a MAP of 64 mmHg, and did not require an increase in the dose of the vasopressor 15 minutes after intubation. No hemodynamic complications were reported after any of the intubations.Conclusions: This case series describes the use of the “ketofol” combination as an induction agent for intubation in critically ill patients when hemodynamic stability is desired. Further research is needed to establish the safety of this combination and how it compares to other induction medications.Background: Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles. No data are available about the use of this combination in critically ill patients undergoing endotracheal intubation.

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