>Can you explain the rationale of even doing a study using propofol +
>ketamine together? What advantage is to be gained by using the two drugs
I think an important distinction here is that Doug is not adding a little
propofol to ketamine, but rather adding a little ketamine to propofol. He
is using standard doses of propofol but then adding low, subdissociative
doses of ketamine (0.5 mg/kg IV). There is no problem with using ketamine
in this fashion; however at this dose ketamine acts solely as an analgesic
and fentanyl could be just as easily substituted.
If one is using full dissociative doses of ketamine (1.5 mg/kg IV or 4
mg/kg IM) there is no need to supplement it with other sedatives such as
propofol, since ketamine alone provides potent analgesia, sedation,
amnesia, and immobilization.
I strongly urge those of you using propofol to prospectively collect data
and publish your experience! Unlike midazolam and ketamine, the safety
profile of propofol in the ED has not yet been sufficiently described.
Steve Green, MD, FACEP
Professor of Emergency Medicine & Pediatrics
Director, Emergency Medicine Residency Program
Loma Linda University Medical Center & Children's Hospital
Loma Linda, California
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