Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Iran.
Acad Emerg Med. 2011 Aug;18(8):800-6. doi: 10.1111/j.1553-2712.2011.01133.x.
The authors performed a prospective, double-blinded, randomized trial with emergency department (ED) patients requiring procedural sedation and analgesia (PSA) for repair of deep traumatic lacerations and reduction of bone fractures, to compare the ketamine/propofol (ketofol) combination with the midazolam/fentanyl (MF) combination.
Sixty-two patients scheduled for PSA who presented between January 2009 and June 2009 were enrolled prospectively. Thirty-one were randomly assigned to the ketofol group, and 31 were assigned to the MF group.
The median starting doses were 0.75 mg/kg of both ketamine and propofol (interquartile range [IQR] = 0.75 to 1.5 mg/kg), 0.04 mg/kg midazolam (IQR = 0.04 to 0.06 mg/kg), and 2 μg/kg fentanyl (IQR = 2 to 3 μg/kg). There were no significant differences in sedation time between the groups. There were no differences in physician satisfaction (p = 0.065). Perceived pain in the ketofol group, as measured by the Visual Analog Scale (VAS), was significantly lower than in the MF group (median ketofol = 0, IQR = 0-1 vs. median MF = 3, IQR = 1-6; p < 0.001). Only one patient in each group required bag-mask ventilation, and neither of them were intubated.
The ketamine/propofol combination provides adequate sedation and analgesia for painful procedures and appears to be a safe and useful technique in the ED.
作者对需要进行程序性镇静和镇痛（PSA）以修复深度创伤性撕裂伤和骨折复位的急诊科（ED）患者进行了一项前瞻性、双盲、随机试验，以比较氯胺酮/丙泊酚（酮氟醚）组合与咪达唑仑/芬太尼（MF）组合。
2009 年 1 月至 6 月期间，前瞻性纳入 62 例计划接受 PSA 的患者。将患者随机分为酮氟醚组和 MF 组，每组 31 例。
氯胺酮和丙泊酚的起始中位剂量均为 0.75mg/kg（四分位间距 [IQR] = 0.75 至 1.5mg/kg），咪达唑仑为 0.04mg/kg（IQR = 0.04 至 0.06mg/kg），芬太尼为 2μg/kg（IQR = 2 至 3μg/kg）。两组镇静时间无显著差异。医生满意度无差异（p = 0.065）。酮氟醚组的视觉模拟评分（VAS）显示疼痛感知明显低于 MF 组（中位数酮氟醚 = 0，IQR = 0-1 与中位数 MF = 3，IQR = 1-6；p<0.001）。每组均有 1 例患者需要进行球囊面罩通气，均未进行气管插管。
氯胺酮/丙泊酚组合可提供充分的镇静和镇痛，适用于疼痛性操作，并且在 ED 中似乎是一种安全有效的技术。
