Table 1 Characteristics of included trials
Study | Intervention | Dose of ketofol | Dose of control | n | Age | Procedure | Outcome |
|---|---|---|---|---|---|---|---|
Canpolat 2012 [19] | Ketofol vs. ketamine-dexmedetomidine | ● 2 mL ketamine (50 mg/mL) + 8 mL NS ● 1 mg/kg propofol followed by 1 mg/kg ketamine ● Additional 1 mg/kg propofol, if needed | ● 2 mL ketamine (50 mg/mL) + 8 mL NS ● 0.5 mL dexmedetomidine (50 μg) + 9.5 mL NS ● 0.5 μg/kg dexmedetomidine followed by 1 mg/kg ketamine ● Additional 0.5 μg/kg dexmedetomidine, if needed | 60 | 8 months to 5 years | Burn injury dressing | 1. Surgeon satisfaction 2. Adverse effects 3. Hemodynamic parameters |
Chiaretti 2011 [13] | Ketofol vs. propofol | ● 0.5 mg/kg ketamine before propofol injection ● 2 mg/kg propofol over 2 min ● 0.5–1 mg/kg additional dose, if required | ● 2 mg/kg bolus over 2 min ● 0.5–1 mg/kg additional dose, if needed | 121 | Ketofol: mean (SD): 6.9 (5.4) years Propofol: mean (SD): 7.3 (5.2) years | Lumbar puncture or bone marrow aspiration | 1. Adverse effects 2. Hemodynamic parameters |
Joshi 2017 [20] | Ketofol vs. dexmedetomidine-ketamine | ● 1 mg/kg propofol, 1 mg/kg ketamine ● Maintenance IV infusion of 100 μg/kg/min of propofol and 1 mg/kg/h of ketamine ● Additional 0.5 mg/kg ketamine, if needed | ● 1 μg/kg dexmedetomidine IV infusion over 1 min + 1 mg/kg ketamine IV bolus ● Maintenance IV infusion of 0.5 μg/kg/h of dexmedetomidine and 1 mg/kg/h of ketamine ● Additional 0.5 mg/kg ketamine, if needed | 60 | 1 month to 6 years | Cardiac catheterisation procedure | 1. Recovery time 2. Hemodynamic parameters |
Khutia 2012 [14] | Ketofol vs. propofol-fentanyl | ● Ratio 1:2 mixing 1 mL ketamine (50 mg/mL) with 10 mL of 1% propofol (10 mg/mL) ● Each mL contains 9 mg propofol: 4.5 mg ketamine ● Bolus: 1 mg/kg propofol, 0.5 mg/kg ketamine ● Infusion of 50 μg/kg/min | ● 10 mL of 1% propofol mixed with 1 mL NS (9 mg/mL) ● 1.5 μg/kg fentanyl diluted to 2 mL of NS ● Bolus: 1 mg/kg propofol, 1.5 μg/kg fentanyl ● Infusion of 50 μg/kg/min | 92 | 3–14 years | Reduction of fracture, I&D abscess, wound debridement | 1. Recovery time 2. Adverse effects 3. Hemodynamic parameters |
Shah 2011 [17] | Ketofol vs. ketamine | ● 0.5 mg/kg ketamine + 0.5 mg/kg propofol ● Additional 0.5 mg/kg propofol, if needed | ● 1 mg/kg ketamine + intralipid placebo ● Additional 0.25 mg/kg ketamine, if needed | 140 | Median (IQR): 11 (7–14) years | Closed manual reduction | 1. Recovery time 2. Adverse events 3. Satisfaction 4. Hemodynamic parameters |
Schmitz 2018 [15] | Ketofol vs. propofol | ● 1 mg/kg ketamine (5%) + 0.5 mg/kg propofol (1%) + 0.03 mL/kg NS ● 5 mg/kg/h propofol infusion | ● 1 mg/kg propofol (1%) bolus ● 10 mg/kg/h propofol infusion | 351 | 3 months to 10 years | Elective MRI | 1. Recovery time 2. Satisfaction 3. Adverse events 4. Hemodynamic parameters |
Tewari 2018 [21] | Ketofol vs. dexmedetomidine-propofol | ● Bolus: 1 mg/kg ketamine + 2 mg/kg propofol over 10 min ● Infusion: 0.5 mg/kg/h ketamine and 4–6 mg/kg/h propofol | ● Bolus: 1 μg/kg dexmedetomidine and 2 mg/kg propofol over 10 min ● Infusion: 0.25–0.75 μg/kg/h dexmedetomidine and 4–6 mg/kg/h propofol | 56 | 7–16 years | Congenital acyanotic heart disease considered amenable for device closure | 1. Recovery time 2. Adverse effects |
Tosun 2007 [16] | Ketofol vs. propofol-fentanyl | ● 0.2 mg/kg ketamine + 1.2 mg/kg propofol ● Additional 0.5–1 mg/kg propofol, if needed | ● 0.2 μg/kg fentanyl + 1.2 μg/kg propofol ● Additional 0.5–1 mg/kg propofol, if needed | 90 | 1–16 years | Upper gastrointestinal endoscope | 1. Recovery time 2. Adverse effects 3. Hemodynamic parameters |
Ulgey 2014 [22] | Ketofol vs. dexmedetomidine- propofol | ● 1 mg/kg ketamine + 1 mg/kg propofol ● Maintenance: 1 mg/kg/h ketamine and 100 μg/kg/min propofol ● Additional 0.5 mg/kg propofol, if needed | ● 1 μg/kg dexmedetomidine for 5 min, 1 mg/kg propofol ● Maintenance: 0.5 μg/kg/h dexmedetomidine and 100 μg/kg/min propofol ● Additional 0.5 mg/kg propofol, if needed | 46 | 3–14 years | Atrial septal defect for transcatheter closure | 1. Recovery time 2. Adverse effects 3. Hemodynamic parameters |
Weisz 2017 [18] | Ketofol vs. ketamine | ● 0.5 mg/kg ketamine and 0.5 mg/kg propofol ● 3 maximum additional doses of 0.25 mg/kg ketamine and 0.25 mg/kg propofol, if needed | ● 1 mg/kg ketamine ● 3 maximum additional doses of 0.5 mg/kg ketamine | 183 | Ketofol: mean (SD): 9.3 (5) Ketamine: mean (SD): 8.3 (6) | Fracture of dislocation reduction | 1. Recovery time 2. Satisfaction 3. Adverse effects |
Yalcin 2018 [23] | Ketofol vs. ketamine vs. propofol | ● Ratio 1:1, 200 mg propofol (20 mL) + 200 mg ketamine (4 mL) ● 0.6 mg/kg bolus followed by 40–60 μg/kg/min infusion | ● 4 mL ketamine diluted with NS to 20 mL, 1 mg/kg bolus followed by 50–60 μg/kg/min ● 2 mg/kg propofol bolus followed by 70–90 μg/kg/min infusion | 75 | 6–12 years | Dental treatment | 1. Recovery time 2. Adverse effects 3. Hemodynamic parameters |