Adverse Events With Ketamine Versus Ketofol for Procedural Sedation on Adults: A Double-blind, Randomized Controlled Trial

Acad Emerg Med. 2017 Dec;24(12):1441-1449. doi: 10.1111/acem.13226. Epub 2017 Jul 14.


Objectives: The goal of our study was to compare the frequency and severity of recovery reactions between ketamine and ketamine-propofol 1:1 admixture ("ketofol").

Methods: We performed a multicentric, randomized, double-blind trial in which adult patients received emergency procedural sedations with ketamine or ketofol. Our primary outcome was the proportion of unpleasant recovery reactions. Other outcomes were frequency of interventions required by these recovery reactions, rates of respiratory or hemodynamic events, emesis, and satisfaction of patients as well as providers.

Results: A total of 152 patients completed the study, 76 in each arm. Compared with ketamine, ketofol determined a 22% reduction in recovery reactions incidence (p < 0.01) and less clinical and pharmacologic interventions required by these reactions. There was no serious adverse event in both groups. Rates in hemodynamic or respiratory events as well as satisfaction scores were similar. Significantly fewer patients experienced emesis with ketofol, with a threefold reduction in incidence compared with ketamine.

Conclusion: We found a significant reduction in recovery reactions and emesis frequencies among adult patients receiving emergency procedural sedations with ketofol, compared with ketamine.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anesthesia
  • Anesthetics, Intravenous / adverse effects*
  • Double-Blind Method
  • Female
  • Hemodynamics
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Ketamine / adverse effects*
  • Male
  • Middle Aged
  • Orthopedic Procedures / adverse effects
  • Pain, Procedural / etiology
  • Pain, Procedural / prevention & control*
  • Propofol / adverse effects*
  • Young Adult


  • Anesthetics, Intravenous
  • Hypnotics and Sedatives
  • Ketamine
  • Propofol