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I rarely use ketofol at Jewish, but will let you guys use it at UL when you want. But this article gives a similar opinion to mine: Ketofol does not hold much benefit if any over Ketamine or Propofol.
For quick procedures where you want muscle relaxation (joint reductions or cardioversion), I use propofol. For painful procedures and trauma patients (traction pins, intubating marginal BP patients, chest tubes) I prefer ketamine.
Propofol with the K does NOT seem to decrease emergence reactions. Though Midazolam does so do give 1-2mg midazolam with your ketamine.
My main issue is anecdotally that the ketofol duration of sedation is noticeably shorter than ketamine. I believe this is due to a lower ketamine dose. And we all know that once the dissociative threshold of ketamine is reached, higher doses simply lengthen the duration of effect. You can’t get “more dissociated” just like you can’t be “very unique.”
I don’t even want to mention etomidate here, as I see only one indication for etomidate (as of 2015 where we are on the brink of taking the head injury stigma away from ketamine).
Article is worth a read.
Hey Martin:
My only comment I would like to point out is that I have seen resident after resident use Ketofol and struggle with procedures that typically require muscle relaxation(esp joint reductions). It’s important to remember that neither agent has relaxation properties and if the doc chooses to use Propofol as a single agent, they need to realize that the analgesia obtained with the Ketamine is lost and that opiates titrated to effect prior to the induction with Propofol is required. I typically add low dose Versed to obtain the needed muscle relaxation especially on younger, muscular patients. This typically results in easy reductions.
Pete