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Table 3 Summary of Findings for Comparison between Ketofol and Combined Agents

From: Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis

Ketofol compared to a combined agent for procedural sedation and analgesia

Patient or population: Procedural Sedation and Analgesia

Intervention: Ketofol

Comparison: Combined agent

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

No. of participants (studies)

Certainty of the evidence (GRADE)

Risk with combined agent

Risk with ketofol

Recovery time

The mean recovery time was 0

MD 0.75 higher (6.24 lower to 7.74 higher)

404 (6 RCTs)

MODERATE a

Recovery time - Dosage ratio 1:1

The mean recovery time - Dosage ratio 1:1 was 0

MD 7.95 lower (21.86 lower to 5.96 higher)

166 (3 RCTs)

LOW b c

Recovery time - Dosage ratio 1:2

The mean recovery time - Dosage ratio 1:2 was 0

MD 14.62 higher (11.09 lower to 40.33 higher)

148 (2 RCTs)

LOW b c

Desaturation

Study population

RR 1.90 (0.15 to 23.60)

150 (2 RCTs)

LOW a c

54 per 1000

103 per 1000 (8 to 1000)

Respiratory depression

Study population

RR 1.98 (0.18 to 21.94)

116 (2 RCTs)

LOW a c

68 per 1000

134 per 1000 (12 to 1000)

Hypotension

Study population

RR 0.42 (0.20 to 0.85)

208 (3 RCTs)

MODERATE c

194 per 1000

82 per 1000 (39 to 165)

Bradycardia

Study population

RR 0.70 (0.14 to 3.63)

298 (4 RCTs)

LOW a c

109 per 1000

76 per 1000 (15 to 395)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; MD: Mean difference; RR: Risk ratio.

GRADE (Working Group grades of evidence)

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect

Very low certainty: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

  1. Footnote:
  2. a Results show large heterogeneity that can be due to the following: 1) different populations: some procedures required a longer duration of treatment, thus, larger doses are required. 2) different ratios of the mixture and dosages of the combination
  3. b Results show large heterogeneity that can be due to different populations and durations of procedures that determine the required dose of intervention
  4. c Small sample size