Ketamine and Propofol Combination (“Ketofol”) for Endotracheal Intubations in Critically Ill Patients: A Case Series
Unusual or unexpected effect of treatment, Unexpected drug reaction , Educational Purpose (only if useful for a systematic review or synthesis)
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 J. Smischney
(Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA)
Am J Case Rep 2015; 16:81-86
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.
Case Report: 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 ≥65 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.
Keywords: Anesthetics, Dissociative - administration & dosage, Aged, Adult, Anesthetics, Intravenous - administration & dosage, Critical Illness - therapy, Drug Therapy, Combination, Female, Humans, Intubation, Intratracheal - methods, Ketamine - administration & dosage, Male, Middle Aged, Pain Management - methods, Propofol - administration & dosage