Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

Pediatr Crit Care Med. 2017 Aug;18(8):e356-e363. doi: 10.1097/PCC.0000000000001246.


Objectives: Outcomes associated with a sedative regimen comprised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers.

Design: Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007-2015.

Setting: Procedural sedation services from academic, community, free-standing children's hospitals, and pediatric wards within general hospitals.

Patients: Children from birth to less than or equal to 21 years old.

Interventions: None.

Measurements and main results: A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, < 1 mo to ≤ 21 yr; interquartile range, 36-144); 80.6% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedation was performed in dedicated sedation or radiology units (76.1%). Procedures were successfully completed in 99.8% of patients. Anticholinergics (glycopyrrolate and atropine) or benzodiazepines (midazolam and lorazepam) were used in 14.2% and 41.3%, respectively. The overall adverse event and serious adverse event rates were 9.79% (95% CI, 9.12-10.49%) and 3.47% (95% CI, 3.07-3.92%), respectively. No deaths occurred. Risk factors associated with an increase in odds of adverse event included ASA status greater than or equal to III, dental suite, cardiac catheterization laboratory or radiology/sedation suite location, a primary diagnosis of having a gastrointestinal illness, and the coadministration of an anticholinergic.

Conclusions: Using Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Anesthetics, Dissociative / administration & dosage*
  • Anesthetics, Dissociative / adverse effects
  • Anesthetics, Intravenous / administration & dosage*
  • Anesthetics, Intravenous / adverse effects
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / adverse effects
  • Infant
  • Infant, Newborn
  • Ketamine / administration & dosage*
  • Ketamine / adverse effects
  • Male
  • Odds Ratio
  • Propofol / administration & dosage*
  • Propofol / adverse effects
  • Retrospective Studies
  • Young Adult


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