Background: Procedural Sedation and Analgesia (PSA) is often necessary in order to deal with anxiety, pain and stress that may accompany patients at the hospital during invasive, unpleasant and/or painful procedures. The literature has not presented firm conclusions regarding ideal sedative agents in terms of efficacy and safety in PSA or even present firm data regarding superiority of specific drugs over others which are considered the “gold-standard” in sedation (i.e. propofol). Ketofol is a combination of ketamine and propofol and is considered to cause less respiratory suppression and haemodynamic instability, ensuring better analgesia and often amnesia, and possibly improved patient satisfaction.

Review question: We reviewed the existing evidence regarding superiority of ketofol in mitigating cardiorespiratory effects when administered as a main agent for PSA in comparison to other drugs administered for such purposes underlying the safety and efficacy profile of this cocktail medication.

Methodology: We conducted an advanced Pubmed research using terms such as “ketofol” or “ketamine and propofol” and “sedati” and “analgesia or pain” in “Title/ABSTRACT” in English language and in population of “Adult: 19+ years”. We found 46 articles appropriate to be included in this review.

Conclusions: It seems that the addition of ketamine to propofol in sub-dissociative doses is associated with less respiratory and haemodynamic complications during PSA, while achieving adequate analgesia and deeper sedation, possibly more amnesia and consequently high satisfaction in both patients and health-care professionals. Frequent sideeffects of ketofol, such as increased psychomimetic complications, nausea and vomiting and perhaps more prolonged recovery do not outweigh its potential benefits during PSA. Therefore, we consider it represents a good choice for PSA, especially for specific populations. Further research with large RCTs is required.

Lampriani Papageorgiou completed his medical degree from the “Medical School of Athens” in Greece and is an owner of 3 master’s degrees in “Molecular Medicine”, “Medical Research, Education and Leadership” and “Algology” from the “Molecular School of Cyprus”, “Cambridge University” and “Ethnic and Kapodistrian University of Athens” respectively. She is currently working as an anaesthesiologist of cardiovascular and thoracic department at the General Hospital of Nicosia at Nicosia, Cyprus.